MODULE 3

AIRBORNE DISEASES

Student Objective:

Upon completing the Chapter, you will be able to:

1. Identify the infectious agent causing the disease.

2. Describe the chain of transmission of airborne diseases and explain

how infectious agents are transmitted.

3. Give the preventive control measures that protects the susceptible

host from communicable disease.

4. Describe the characteristic symptoms of an affected person.

5. List down the medical and nursing management for treating the
affected person.

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 PRETEST

Direction: Choose the letter of the correct answer. Select all that applies.
1. Which of the following is the mode of transmission of coryza?
a. Airborne
b. Direct contact
c. Droplet infection
d. Fecal-oral route
2. Which of the following statements are true concerning chicken pox?
a. May be isolated in an open ward.
b. Is an air borne disease
c. Has carrier state.
d. One attack usually produces lifelong immunity.
3. Complications which may occur with chicken pox are.
a. Bronchopneumonia
b. Nephritis
c. Impetigo
d. Nephrosis
4. Which is true about Koplik’s spots?
a. Are pathognomonic to measles.
b. They appear in the buccal cavity.
c. They appear after the exanthema.
d. They are tiny bluish or bluish white specks.
5. Another name for mumps is?
a. Glanders
b. Pertusis
c. Infectious parotitis
d. Infectious hepatitis
6. Which of the following signs are found in German measles?
a. Enlarged glands behind the ears.
b. Cervical adenitis
c. Koplik’s spots
d. Stimson’s line

50
 PRETEST

7. The causative agent of smallpox may be found in?

a. urine
b. stool
c. vaginal secretions
d. secretions from lesions.
8. What laboratory test confirms the diagnosis of Leprosy?
a. skin smear
b. Tissue biopsy
c. utrasonogram
d. Computed Tomography scan
9. What is the prophylactic treatment for meningitis?
a. vaccine
b. Rifampicin
c. Sulfonamides
d. Chloromycetin
10. What is the mode of transmission of pneumonia?
a. droplet infection
b. indirect contact
c. fecal-oral route
d. vector
11. What are the sources of infection of tuberculosis?
a. sputum
b. saliva
c. nasal discharge
d. . blood from hemoptysis

12. What is the treatment for pediculosis?

a. Anti-dandruff shampoo
b. Blackenning shampoo
c. Keratin Shampoo
d. Kwell shampoo

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 ACUTE RHITNITIS

Rhinitis is a group of disorders characterized by inflammation and

irritation of the mucous membranes of the nose. These conditions
can have a significant impact on quality of life and contribute to
sinus, ear, and sleep problems and learning disorders. (Nihlén,
Greiff, Montnémery, et al., 2006).

It is common kind is allergic rhinitis. Colds are highly contagious

because virus shed for about 2 days before the symptoms appear
and during the first part of symptomatic phase.

Mode of Transmission : -Droplet Infection

Causative Agent: -Cold Virus or Rhino Virus

Incubation Period: 1-4 days

Period of Communicability:

AT EARLY STAGE:

Symptoms:
rhinorrhea
sneezing
slight headache
nasal itching
watery, reddened, itchy eyes
& puffiness around eyes
Itchiness of the throat
chills
lacrimation

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 ACUTE RHINITIS
(Coryza, Common Colds)

LATE STAGE:
stuffy nose & post nasal drip
profuse mucoid secretions
nasal congestion
cough
thick & purulent secretions
smell & taste disrupted
sore throat (pharyngitis)
ear itchiness
Fatigue
malaise
Figure 1 VACCINES (Alta Science.com)

)
PREVENTION:
Vaccination

MANAGEMENT:
Symptomatic
-Depends on underlying cause
-Intranasal corticosteroids
-Intranasal antihistamines

NURSING CARE:
1. Place in a well-ventilated room.
2. Complete Bed Rest
3. Vitamin C to increase body resistance.
4. Increase Fluid intake

53
 ACUTE RHINITIS
(Coryza, Common Colds)

MEASLES
Synonyms: Rubeola, Morbilli, Little red disease, Hard measles, 7
day measles, 9 day measles
Measles is an acute, contagious and exanthematous disease that
usually affects children who are susceptible to upper respiratory tract
infection (URTI). This may be one of the most common and most
serious of all childhood diseases.
Etiologic Agent:
A filterable virus which belongs to the genus Morbilivirus of
the family Paramyxoviridae is the agent of measles. The measles
virus is rapidly inactivated by heat, ultraviolet light and extreme
degrees of acidity and alkalinity.
Incubation Period :
1. The incubation period is from ten to twelve days (the longest is 20
days and the shortest is eight days.)
2. A single attack conveys lifelong immunity.

Figure 2 : Rubeola (Shutterstock.com)

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 MEASLES

Period of Communicability Mode of Transmission:

1. Measles usually lasts about 9 to 10 1. The disease is
days, measured from the beginning of transmitted through
the prodromal symptoms to the fading direct contact with the
of the rashes. droplets spread
2. The disease is communicable four days through coughing and
before and five days after the sneezing.
appearance of rashes. 2. It can be transmitted
3. The disease is most communicable at indirectly through
the height of the rash. articles or fomites
freshly contaminated
Sources of Infection: with respiratory
The virus has been found in secretions of infected
patient’s blood, as well as in patients.
the secretions from the Pathognomonic Sign:
eyes, nose and throat. Koplik’s spots are
pathognomonic of measles.
These are inflammatory lesions
of the buccal mucous glands
with superficial necrosis.

Figure 3 Eyes and nose secretions (Shutterstock.com) Figure 4.0 Koplik’s spots (Wikipedia)

55
 MEASLES

1. They appear on the mucosa of the inner

cheek opposite to the second molars, or
near the junction of the gum and the
inner cheek.
2. They usually appear one or two days
before the measles rash.

CLINICAL MANIFESTATIONS
Clinical manifestations come in three stages:
1. Pre-eruptive Stage
a. Fever
b. Catarrhal symptoms (rhinitis, photophobia, coryza
c. Respiratory symptoms start from common colds to persistent
coughing.
d. Enanthen sign (Koplik’s spot, Stimson’s line.

2. Eruptive Stage
a. A maculo-papular rash usually starts to appear late on the 4th
day.
b. The maculo-papular rash appears first on the cheeks, bridge of
the nose, temples, earlobes or along the hairline.
c. The rash is fully developed by the end of the second day and all
symptoms are at their most severe at this time.
d. High grade fever comes on and off.
e. Anorexia and irritability
f. Abdominal tympanism, pruritus and lethargy.
g. The throat is red and often extremely sore.
h. As fever subsides, coughing may diminish, but more often it
hangs on for a week or two and becomes looser and less
metallic.

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3. Stage of convalescence
a. Rashes fade away in the
same manner as they
erupted.
b. Fever subsides as rashes
starts to fade.
c. When the rashes have
faded, desquamation
begins.
d. Symptoms subside and
appetite is restored.
MODALITIES OF TREATMENT
Diagnostic Procedure
1. Antiviral drugs
1. Nose and throat swab
(Isoprinosine)
2. Urinalysis
2. Antibiotics if with
3. Blood exams
complication.leukocyosis)
Leukopenia,
3. Supportive therapy
4. Complement fixation
(oxygen inhalation,
hemogglutinin test IV fluids)
NURSING MANAGEMENT
1. Isolation of patient is
necessary.
2. Control the patient’s high
temperature with warm or
tepid sponges.
3. Skin care is of utmost
importance. The patient
should have a daily
cleansing bed bath.
NURSING MANAGEMENT
4. Oral and nasal hygiene.
5. Care of the eyes is
necessary. The patient is
sensitive to light. Therefore,
position the patient in such a
way that direct glare of light is
avoided. Keep eyes free of
secretions.
6. Care of the ears is also
important. Be alert for any
signs of early mastoid
infection.
7. Daily elimination is
(CBC<
important. This can be
accomplished with a mild
or
laxative, as prescribed by
the physician.
8. During the febrile stage, limit
the diet for fruit juices, milk,
and water. If patient is
vomiting, give frequent,
small servings of iced juices.
9. The patient’s position should
be changed every three to
four hours.
10. Penicillin or other prescribed
medications, are usually
given in cases where there is
complications.
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 MEASLES

COMPLICATIONS
1. Bronchopneumon
ia
2. Otitis media
3. Pneumonia /
Bronchitis
4. Nephritis
5. Encephalitis,
encephalomyelitis
6. Blindness

Figure Sponge Bath (Shutterstock.com)

PREVENTIVE MEASURES
1. Immunization with anti-measles at the age of 9 months, as a
single dose. The first dose of the measles-mumps-rubella (MMR)
vaccine is given at 15 months old, second dose at 11-12 years
2. Avoid overcrowded places to lessen the chances of contracting
the virus.

MEASLES

58
 GERMAN MEASLES
(Rubella)
DEFINITION

An acute contagious
disease characterized by
mild constitutional
symptoms, and a rose-
colored macular eruption
which sometimes resemble
measles and at other times,
scarlet fever. It causes mild,
feverish illness associated
with rashes and aches in
joints. It has a teratogenic Figure 5 Rubella (Shutterstock.com)
effect on fetus.
Rubella can affect anyone of any age and is generally a mild disease, rare
in infants or those over the age of 40. The older the person is, the more
severe symptoms are likely to be.. Up to one third of older girls or women
experience joint pain or arthritic type symptoms with rubella.
Infectious Agent
Rubella virus (Family-Togaviridae, Genus-Rubivirus
Incubation Period
From exposure to the appearance of the rash, the incubation is usually
14 to 21 days.
Mode of Transmission
1. Direct contact with nasopharyngeal secretions.
2. Air droplets.
3. Transplacental transmission in congenital rubella.
4. Infants with congenital rubella shed large quantities of the virus
through their pharyngeal secretions and urine, which serve as a
sources of infection to other contacts.

59
 GERMAN MEASLES

Period of Communicability
The virus is communicable
approximately one week before and
four days after the onset of the
rash, but is at its worst when the
rash is at its peak. Highly
communicable infants with
congenital rubella may shed virus
for months after birth.

Clinical Manifestations
1. Prodromal period
a. Low-grade fever
b. Head ache
c. Malaise
d. Mild coryza
e. Conjunctivitis
f. Post auricular, sub-occipital, and posterior cervical
lymphadenopathy which occurs on the third to the fifth days after
onset

2. Eruptive period
a. A pinkish rash on the soft palate (Forcheimer’s Spots), an
exanthematous rash that appears first on face, spreading to the
neck, the arms, trunk, and legs.

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 GERMAN MEASLES

b. Eruption appears after the onset of adenopathy.

c. Children usually present less or no constitutional symptoms.
d. The rash may last for one to five days and leaves no pigmentation nor
desquamation.
e. Testicular pain in young adults.
f. Transient polyarthralgia and polyarthritis may occur in adults and
occasionally in children.

MODALITIES OF TREATMENT
Very little treatment is necessary; treatment is essentially symptomatic.

COMPLICATIONS
1. Encephalitis
2. Neuritis
3. Arthritis
4. Arthralgias
5. Rubella syndrome (microcephally, mental retardation, cataract, deaf-
mutism, heart disease

NURSING MANAGEMENT
1. The patient should be isolated.
2. The patient should be advised to rest in bed until fever subsides
3. The patient room must be darkened to avoid photophobia.
4. The patient must take a mild liquid but nourishing diet.

GERMAN MEASLES

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 GERMAN MEASLES

Figure 6 – Darkened the room, Figure 10 – Liquid nourishing diet

NURSING MANAGEMENT
5. The patient’s eyes should be irrigated with warm normal saline to
relieve irritation.
6. The ears must be taken care of. Do not apply heat or cold compress
unless ordered.
7. Good ventilation is necessary.
8. The spread of infection must be prevented.
9. The occurrences of complications must also be prevented.
10. Encourage increased fluid intake.

PREVENTION

1. Administration of live attenuated vaccine (MMR).

2. Pregnant women should avoid exposure to patients infected with
rubella virus.
3. Administration of immune serum globulin one week after exposure
to rubella.
4. Prevent spread of infection by minimizing contact with visitors.

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 CHICKENPOX
(Varicella)

DEFINITION:
Chickenpox is an
acute and highly contagious
disease of viral etiology that
is characterized by
vesicular eruptions on the
skin and mucous
membrane with mild
constitutional symptoms.

INFECTIOUS AGENT:
Herpesvirus varicellae – a
DNA –containing virus.
1. Human beings are the
only source of infection.
2. This is closely related or
identical to herpes
zoster virus.

Figure 11- Chickenpox (Shutterstock.com)

INCUBATION PERIOD

The incubation period is 10 to 21 days or may be prolonged after

passive immunization against chickenpox.

PERIOD OF COMMUNICABILITY
The patient is capable of transmitting the disease about a day before the
eruption of the first lesion up to about five days after the appearance of the
last crop.

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 CHICKENPOX

MODE OF TRANSMISSION

1. Direct contact with a patient who sheds the virus from the vesicles.
2. Indirect contact, through linens or fomites.
3. Airborne, or spread by aerosolized droplets from the nasopharynx of ill
individuals.
4. High viral titers are found in the vesicles of chickenpox; thus, viral
transmission may also occur through direct contact with these
vesicles, although the risk is lower.
5. Following primary infection there is usually lifelong protective immunity
from further episodes of chickenpox.

PATHOPHYSIOLOGY

1. Inhalation of contaminated respiratory droplets.

2. Proliferation of virus in regional lymph nodes of the upper respiratory
tract.
3. Viral replication occurs in the body’s internal organs, the liver and the
spleen.
4. Diffused viral invasion of capillary endothelial cells and the epidermis.
5. Intercellular and intracellular edema because of VZV infection of cells
of the Malphigian layers resulting in the characteristic vesicle.

HICK
ENPOX

64
 Chickenpox

f. All stages are present

simultaneously before all
are covered with scabs
leading to the appearance
known as “celestial map.”
g. The stages are
characterized as follows:
• Macule is a lesion
Figure 12- Primary Lesions (Shutterstock.Com) that is not elevated above
the skin surface.
• Papule is a lesion
CLINICAL MANIFESTATIONS that is elevated above the
skin surface with a diameter
1. Pre-eruptive manifestations are mild of about 3 mm.
fever and malaise. • Vesicle is a pop-like
2. Eruptive stage. eruption filled with fluid that
a. Rash starts on the trunk easily burst and dries up in
(unexposed area), then spreads to three to five days.
another parts of the body. • Pustule is a vesicle
b. Initial lesions are distinctively red that is infected or filled with
papules whose contents become pus. If becomes infected the
milky and pus-like within four days. scar may be big and wide.
c. In adults and bigger children, the • Crust is a scab or
lesions are more widespread and eschar. This is a secondary
more severe. lesion caused by the
d. There is rapid progression so that secretion of vesicle drying
transition is completed in six to on the skin. The scars are
eight hours. superficial, depigmented
e. Vesicular lesions are very pruritic. and take time to fade out.

CHICKENPOX
(Varicella)

65
 CHICKENPOX

DIAGNOSTIC TEST NURSING MANAGEMENT

1. Determination of the V-Z
virus through the
complement fixation test.
2. Determination of the V-Z
virus through electron
microscopic examination of
vesicular fluid.
COMPLICATIONS
1. Chickenpox is rarely
fatal, although it is
generally more severe in
adults than in children.
2. Pregnant women and
those with a suppressed
immune system are at
the highest risk of serious
complications.
3. The most common late
complication
chickenpox is shingles,
caused by reactivation of
the varicella zoster virus
decades after the initial
episode of chicken pox.
4. Secondary infection of
the lesions-furuncles,
cellulitis, skin abscess,
erysipelas.
5. Meningoencephalitis
6. Pneumonia
7. Sepsis.
1. Respiratory isolation is a must until all
vesicles have crusted.
2. Prevent secondary infection of the skin
lesions through hygienic care of the
patient.
3. Attention should be given to
nasopharyngeal secretions and
discharges. Linens must be disinfected
under the sunlight or through boiling.
4. Cut fingernails short and wash hands
more often to minimize bacterial
infections that may be introduced by
scratching.
5. A child must wear mittens.
6. Provide activities to keep child occupied
to lessen pruritus.
7. Observe oral and nasal care as rashes
may appear in the buccal cavity.
of
Figure 19- Mittens (Shutterstock.com)

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 CHICKENPOX

TREATMENT PREVENTIVE MEASURES

MODALITIES 1. Active immunization
1. Oral acyclovir 800 with live, attenuated
mg 3x a day for five varicella vaccine is
days must also be necessary.
given. 2. Avoid exposure as
2. Oral antihistamine much as possible to
can be taken to infected persons.
symptomatic pruritus. 3. Patient must be
3. Calamine lotion isolated to avoid
eases itchiness transmission of
4. Salicylates must not organism to other
be given. members of the
5. Antipyretic might be family.
given for fever.
6. Antihistamine must
be given. SMALL POX
(

Figure Comparisson between chickenpox and Shingles (Top Health fix)

67
 SMALL POX
(Variola)

Small pox is an acute highly

contagious disease cause by a CONVALESCENT
filtrable virus, characterized by • Desquamation-leaving
severe constitutional symptoms & a pitted scar
macular eruption & appears about (POCKMARK)
the 4th day of the disease & changes • Become confluent
rapidly through distinct papular- (merging)
vesicular, pustular & crusting stages.
Leaving a pitted scar. (CDC,2016). TYPES:
Causative Agent: VARIOLA POX 1. VARIOLA MINOR
VIRUS (ALASTRIM)
Incubation Period : 7-16 days • milder form, fewer
systemic symptoms, a
Mode Of Transmission :
less extensive rash,
DIRECT OR INDIRECT CONTACT less scarring, and
Period of Communicability fewer fatalities.
• 1st signs and symptoms up to • Mild prodromal signs
the last crust and symptoms
PRODROMAL S/S 2. VARIOLA MAJOR
• sudden onset of fever, headache, (CLASSICAL)
erythematous eruption • virus to move from cell
• headache, severe backache, to cell
enanthem • virus was found in the
ERUPTIVE(rash formation) bloodstream in large
A. Period of Maculo-popular rashes numbers (viremia)
(2nd day) • second wave of
B. Period of Vesiculation (3rd, 4th multiplication occurred
day),multilocular (more division) in the spleen, bone
C. Period of Pustular, (fever appears marrow, and lymph
with prominent umbilication ) nodes.

SMALLPOX
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 SMALLPOX

Figure 14 Comparison of progression of smallpox rash and chicken pox rash. From World
Health Organization. (2001). WHO slide set on the diagnosis of smallpox. Reproduced by
permission of the World Health Organization. Available at:
www.who.int/emc/diseases/smallpox/slideset/index.htm

Four types of Varicella Major

1. Ordinary-Ninety percent or more cases among unvaccinated
persons.
1. Modified-occurred mostly in previously vaccinated people. This
form of variola major was more easily confused with chickenpox.
3. Malignant (or flat)- prolonged high fever, and severe symptoms of
toxemia; was nearly always fatal, vesicles are flat ; severe
prodromal signs and symptoms.
4. Hemorrhagic (black pox)- a severe form accompanied by
extensive bleeding into the skin, mucous membranes, and
gastrointestinal tract

69
 SMALLPOX

Diagnosis
• Electronmicrosco
pe using vesicle
fluid
• Compliment
fixation test
(CFT)- presence
of either specific
antibody or
specific antigen
• Culture and
Sensitivity
Figure 15. Child’s Torso with small pox (Shutterstock.com)

TREATMENT
SYMPTOMATIC
1. Supportive measures
• MgSo4, KMNO4, IV, liquid or soft diet
2. Use of anti-viral,antibiotic
• Tecovirimat (TPOXX)
• In laboratory tests, cidofovir and brincidofovir have been shown to
be effective against the virus that causes smallpox.

SMALL POX

70
 SMALLPOX

NURSING CARE
1. The patient must be isolated with the use of transmission precautions.
2. Medical Asepsis
3. Complete Bed Rest
4. Oral/Nasal hygiene
5. Nutritional Diet
COMPLICATIONS
• Secondary infection of skin -Dermatitis; pyoderma; gangrene;
abscess; furuncles.
• Respiratory tract complications-Pharyngitis; bronchopneumonia;
sinusitis; pleurisy; empyema.
• Otitis media
• Pustulation on the eyelids often leads to conjunctivitis,
occasionally to corneal ulceration and blindness.
• Systemic –hepatitis and nephritis

Figure Small pox (Castro, 2020)

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 HAND, FOOT AND MOUTH
DISEASE
DIFINITION:
Hand, foot, and mouth
disease, or HFMD, is a
contagious illness caused
by different viruses. It is
common in infants and
children younger than 5
years old. However, older
children and adults can also
get HFMD (CDC,2020).
Figure Hand Foot and Mouth
Disease in Children
(Shutterstock.Com)
Causative agent:
Coxsackievirus
Mode of Transmission:
Direct contact with nose and
throat secretions and with feces of
infected
people.
Incubation Period
3 to 5 days
Clinical Manifestation:
• Mouth sores
• Skin rash of flat red spots that
may blister
• Fever
• Sore throat
• Loss of appetite
Treatment:
• Most people do not need to
see a doctor for hand, foot,
and mouth disease.
• Treat the illness at home by
relieving symptoms and
making sure the sick person
drinks enough fluids to stay
hydrated.
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 HAND, FOOT AND MOUTH
DISEASE
Prevention and Control

• Wash your
hands often with
soap and water for at
least 20 seconds.
• Clean and
disinfect dirty
surfaces and soiled
items.
• Avoid close Figure Hand ,foot and mouth disease (Shutterstock)
contact with sick
people, like hugging
or kissing.

Figure Hand, Foot and mouth disease (Triche, 2019)

73