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diseases in



Communicable diseases spread from one person to

another or from an animal to a person.

The spread often happens via airborne viruses or
bacteria, but also through blood or other bodily fluid.
The terms infectious and contagious are also used to
describe communicable disease.
In this section, we will learn about coordinated
efforts to combat a few of the most serious
communicable diseases on a global level.

A convenient method is to classify communicable

diseases according to the mode of transmission.

Such classification facilitates the control of these
diseases because transmission is the most vulnerable
part in the chain of spread.
The measures of prevention and control, in general,
are similar for diseases in the same group.It is again
relatively difficult to tackle the causative agent at the
source since the source, in most cases is the man

In practice, one finds it comparatively easier to

attack the agent in the environment in relation to the

vehicle of transmission.
In this background, communicable diseases are
grouped into airborne or respiratory infections,
water and food-borne or intestinal infections,
contact or surface infections and arthropod-borne

Air-borne Infections

The causative agents produce infection and disease

after they are inhaled.

The primary pathological process is usually in the
respiratory tract.
The infection may ultimately manifest as a
respiratory disease (e.g. diphtheria, tuberculosis) or
as a no respiratory disease (smallpox, measles,
The air-borne or respiratory infections have four
different modes of spread.

Air borne or respiratory infections

a. General
a. General
1. Common cold
1. Pneumonia
2. Influenza
2. Streptococcal sore throat, acute
3. Adenovirus
and rheumatic fever
4. Viral encephalitis b. Specific*
b. Specific
1. Diphtheria
1. Smallpox
2. Whooping cough
2. Chickenpox
3. Tuberculosis
3. Measles
4. Meningococcal meningitis
4. Rubella
5. Mumps

Water and Food-borne (Intestinal) Infections

That spread through contamination of water and food.

Such contamination is usually fecal in nature.

The infecting agent enters the body along with water
and food, multiples in intestines and is passed out in
stools. When infected stools contaminate water, milk,
food, hands or fomites, it leads to further spread of
infection. Flies and dust can also provide a link between
feces and food.
The infecting organism may not have its breeding
ground in the intestine, and may not always enter by
mouth or leave through anus in case of some worms.

Water and food-borne infections




Enteric fever



The infection comes out of the skin or mucous

membrane of the patient and enters through the

skin and mucous membrane of a healthy person
through bodily or sex contact.
The infection may also be carried indirectly
through fomites, such as kajal stick and
handkerchief in case of trachoma, towels in case
of gonorrheal vulvovaginitis and socks in case of

Arthropod-borne Infections
As mechanical carriers: When the infection is carried on the wings,

legs, and mouth parts of flies, etc. Food and drinks become infected
when flies sit on them. Cholera and some other water and foodborne
diseases are spread in this manner.
As biological vectors: When the disease agent develops or multiplies in
the body of the vector. In many cases, vector is the definitive host while
man is the intermediate host. The time passed by the agent in the
vectors body is called extrinsic incubation period. The vector is not
infective during this period
The agent may be transferred from arthropod to man by inoculation
(e.g. mosquito bite), or by contamination of skin. Such contamination
may occur through infective feces of the vector in case of housefly and
through infected body fluids in case of louse when it gets crushed on
the skin.

Mode of transmission
Direct droplet transmission: Droplets of sputum from

nose and mouth of one person are projected directly on to

the conjunctiva or into the nose and mouth of another
person in close proximity during the acts of breathing,
coughing, talking, laughing, or sneezing. This can happen
upto a distance of one meter between two persons and takes
place in case of agents having low viability, such as those of
common cold and whooping cough.
Direct air-borne: Some droplets or droplet nuclei are
inhaled with air directly as they remain suspended in the air
and are carried by air currents over longer distance. Measles
and chickenpox spread in this manner.

Indirect air-borne: Some large droplets fall on the clothes,

cots or floor and remain there, making them secondary

reservoirs of infection. When these droplets dry up, the
pathogens are inhaled as such or along with dust during bedmaking, dusting and sweeping. The agents may even be carried
by air currents and inhaled later. Such transmission occurs in
psittacosis, typhus fever, streptococcal sore throat and
Contact transmission: It makes place directly by kissing
and indirectly through contaminated food, milk, hands, surgical
instruments and other fomites when they are put in the mouth.
Examples are streptococcal sore throat and diphtheria.

The following infections

Nonspecific viral infections

Common cold
Specific viral infections
Smallpox (Variola)
Chickenpox (Varicella)
Measles (Rubeola)
German measles (Rubella)
Nonspecific bacterial infections
Streptococcal sore throat
Specific bacterial infections

Nonspecific Viral Infections

Common Cold (Acute Coryza)

Most of these viral infections affect the upper respiratory tract, but lower

respiratory tract can be involved in certain groups particularly in young age

group and in certain epidemiological settings. The illness caused by
respiratory viruses expressed into multiple distinct syndromes, such as
common cold, pharyngitis, croup, tracheo-bronchitis, bronchiolitis,
pneumonia, etc.
It occurs more in winter and in cold climates. It is an acute infection of the
respiratory tract characterized by sneezing, running nose, nasopharyngeal
irritation and malaise lasting two to seven days.
Fever is rare. The infectious agent is a rhinovirus with more than 100
serotypes. The patient is highly infective 24 hours preceding and five days
following the onset of the disease. Transmission is by droplet method or
through fomites such as handkerchief. Susceptibility is general. Immunity is
shortlived and lasts for a month or so. Incubation period is 12 to 72 (usually
24) hours.
There is no specific treatment. Cold vaccines have been used but the results
are not encouraging

Influenza is an acute infectious respiratory disease

caused by RNA viruses of the family

orthomyxoviridae(the influenza viruses).
The influenza virus, known to be circulating as a human
pathogen since at least the16th century is notable for its
unique ability to cause recurrent epidemics and global

Infection with influenza may be asymptomatic but

usually gives rise to fever and typical prostrating

disease, characteristic in epidemics.
Usual symptoms are flushed face, congested
conjunctiva, cough, sore throat, and fever for two to
three days, headache, myalgia, back pains and
marked weakness.
Pneumonia due to secondary bacterial infection is
the most common complication


Influenza viruses are RNA viruses of orthomyxoviridae family. The

virus has three distinct genera (types A, B or C) based on antigenic

differences of their nucleo and matrix proteins.
Virus: the hemagglutinin (H) and the neuraminidase (N).
Currently among many subtypes of viruses, influenzaA (H1N1) viruses,
influenza A (H3N2) viruses, and influenza B viruses are circulating
worldwide in human.
Epidemics are primarily caused by type A viruses and occasionally by
type B in human being. Type C influenza virus has been associated
with sporadic cases and minor localized outbreaks.
Avian influenza viruses (AIV) belong to type A influenza virus.

Age and sex: As mentioned earlier, the influenza

virus maximally attacks those in the age group 5

to 15 years but no age group or sex is spared.
Rates of infection are highest among children
Immunity: The antibody to H type of antigen
prevents initiation of the infection while that to
N antigen prevents virus release and spread The
level drops to pre infection level by 8 to 12

Influenza viruses predominantly transmitted through

respiratory droplets of coughs and sneezes from an

infected person.
Influenza viruses may also spread through direct (skin
to skin) or indirect contact with infected material, which
ultimately enters through nasopharyngeal route.
Transmission of viruses starts one day before the onset
of symptoms and continue up to five to seven days after
the symptoms subsides.

Incubation Period
The incubation time for influenza ranges from one to

five days with an average of two days.

Traditionally, the definitive diagnosis of influenza is made either on the

basis of virus isolation or by serology

Detection of antigen in nasal secretions by:
a) Rapid test: It can be used to detect influenza viruses within 30 minutes.
b) Immunofluorescence test
c) Antigen capture ELISA with monoclonal antibody to the nucleoprotein
d) Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)
)Virus isolation:
a) Cell line Madin-Darby Canine Kidney cells (MDCK)
b) Egg inoculation
)Serological test in paired serum samples

Antibiotics for bacterial complications of influenza
Antiviral therapy
Management of contacts may include-antiviral prophylaxis and

advice about relevant vaccination (e.g. pandemic strain vaccine if

Prevention and control strategies: People with respiratory
infection symptoms should practice the following respiratory
etiquette. All symptomatic people should:
Avoid close contact (less than 1 meter) with other people.
Cover their nose and mouth when coughing or sneezing.
Use disposable tissues to contain respiratory secretions.
Immediately dispose off used tissues.

Social distancing
Crowded places and large gatherings of people should be

avoided at the time of an influenza pandemic, whether

such gatherings are open or closed spaces.
A distance of at least 1 meter should be maintained
between persons wherever possible
Any form of contact with people who are unwell with
pandemic influenza, including visitors, should be
avoided wherever practicable.
Movement of people in and out of the area will be
effectively restricted to prevent further spread to
unaffected areas


Amantadine 5 mg/kg/day up 5 mg/kg/day

Specific Viral Infections

Smallpox (Variola)
Smallpox has been one of the greatest sources

and a major killer of mankind.

Till the discovery of vaccination, smallpox was
responsible for the death of one out of every five
children below five years of age.
In October 1979, the WHO certified that
smallpox had been eradicated from the world.
This was confirmed by the World Health
Assembly on 8th May 1980

Differences between smallpox and chickenpox
Incubation period
7-17 days, average 12
7-12 days, average 15
For 2-3 days at the onset and One day at the onset rising with
again when pustules appear.
each fresh crop of lesions
Prodromal symptoms
Appearance and progress

First on periphery and then
towards center, (centrifugal)
Appears on 3rd day and
progresses in stages
Pustules 1 cm or more in size
Slow, deliberate and majestic
Disfiguration, blindness and
Leaves pitted scars

First on trunk and then towards
periphery, (centripetal)
Appears on 1st day and comes in
Small, elliptical, mostly discrete;
Very rapid
Residual sequelae rare. Leaves
only pink
stains but not permanent or pitted

Fig 1 small pox

LABORATORY DIAGNOSIS: This is confirmed by

Tissue culture
Serological examination
Electron microscopy

Chickenpox (Varicella)

Chickenpox is important because it is mistaken with a

more dangerous disease, i.e. modified smallpox.

Symptoms and signs of the two have already been
Chickenpox is a mild disease but varies in intensity. There
may be just one to two pocks or the disease may take
serious and fatal, though rare, forms such as varicella
bullosa, v. gangrenosa &v. hemorrhagica.
Encephalitis and pneumonia are rare complications.

Fig 2 chicken pox

Types of chickenpox

Breakthrough Varicella
In previously immunized children asymptomatic

infection with wild type of virus may occur.

When a child develops rash after 42 days of
chickenpox vaccination and is due to wild type of
Varicella-Zoster virus, is known as breakthrough
This breakthrough varicella should be isolated, since
they are infectious.

Progressive Varicella
Progressive varicella is one of the worst

complications of primary Varicella-Zoster virus

infection, characterized by severe hemorrhage,
coagulopathy and continued development of lesions.
Immunocompromised children, pregnant women
and newborns are most susceptible

Congenital Varicella Syndrome

Congenital Varicella Syndrome develops among two

percent of fetuses whose mothers had varicella within first

20 weeks of pregnancy.
Limb development is hampered when fetus is infected at
6 to 12 weeks of gestation.
Eye and brain development is interrupted, when infection
at 16 to 20 weeks of gestation.
Horner syndrome and dysfunction of the urethral or anal
sphincters may be developed due to viral damage of the
sympathetic fibers in the cervical and lumbosacral cord.

At first leucopenia for first 72 hours; followed by a relative and

absolute lymphocytosis.
VZV immunoglobulin G (IgG) antibodies can be detected by
several methods and a 4-fold rise in IgG antibodies is also
confirmatory of acute infection.
CSF: Mild lymphocytic pleocytosis and increase in protein in the
cerebrospinal fluid; glucose concentration being normal.
Direct fluorescence assay (DFA) from skin lesions, polymerase
chain reaction (PCR) and Tzanck smear or Calcofluor stain to
detect multinucleated giant cells.

Oral therapy with acyclovir (20 mg/kg/dose; maximum:

800 mg/dose) given as four doses per day for five days is
the drug of choice. In healthy adults, acyclovir 800 mg is
given five times a day orally for five days.
Immunocompromised patients benefit from both
symptomatic and antiviral therapy. Oral acyclovir
administered late in the incubation period may modify
subsequent varicella in the normal child. However, its use
in this manner is not recommended until it can be further
evaluated. When acyclovir resistance is seen then foscarnet
is used

The complications are more commonly seen in immunocompromised

Mild thrombocytopenia, purpura, hemorrhagic vesicles, hematuria and
gastrointestinal bleeding. Cerebellar ataxia, encephalitis, pneumonia,
nephritis, nephritic syndrome, hemolytic-uremic syndrome,
arthritis, myocarditis, pericarditis,
pancreatitis, and orchitis.
Secondary bacterial infections, with group Ahemolytic streptococci and
Staphylococcus aureus, are common.
Cellulitis, erysipelas, osteomyelitis, and rarely meningitis are observed.
Pitted scars are frequent sequelae.
Among AIDS patients Varicella-Zoster virus causes acute retinal necrosis
and progressive outer retinal necrosis

Passive and active Immunization


Agent: Paramyxovirus
Incubation period: 10 to 20 days
Communicable period: From 4 days before to 5

days after rash appears, mainly during prodromal

stage (pertaining to early symptoms that may mark
the onset of disease)
Source: Respiratory tract secretions, blood, or urine
of infected person
Transmission: Airborne particles or direct contact
with infectious droplets; transplacental

The three Cscoryza, cough, conjunctivitis
Rash appears as red, erythematous maculopapular

eruption starting on the face and spreading downward to

the feet; blanches easily with pressure and gradually
turns a brownish color (lasts 6 to 7 days); may have

Kopliks spots: Small red spots with a bluish white

center and a red base; located on the buccalmucosa

and last 3 days

Fig 3 Measels spot

Laboratory confirmed measles

A case that meets the clinical case definition and

presence of measles specific IgM antibodies in the

serum, or at least fourfold increase in antibody titer
or isolation of measles virus.

otitis media (515%)
Pneumonia (510%).
Bleeding from skin and mucosa may occur (Black

subacute sclerosing panencephalitis (SSPE)

Case Management of Measles Case management depends upon severity of disease.

Uncomplicated measles
Child with measles and absence of signs and

symptoms of complicated or severe disease. This

children requires supportive measures like
Vitamin A oil is given to all children,
Breastfeeding is continued along with
complementary feeding or fluids as usual, green leafy
vegetables, yellow fruits, etc.
ORS given in case of diarrhea, fever is treated with
paracetamol to reduce risk of convulsion.

Complicated measles
Same as mentioned in uncomplicated measles. In

addition eye lesions are cleaned and treated with one

percent tetracycline eye ointment three times a day
for seven days.
Ear discharges are cleaned and treated with
Pneumonia is also treated. The patient is referred to
a health facility for further management

Use airborne droplet precautions if the child is

Restrict child to quiet activities and bedrest.
Use a cool mist vaporizer for cough and coryza.
Dim lights if photophobia is present.
Administer antipyretics for fever.

Rationale of giving at nine months of age

Measles vaccine interacts with maternally derived

antibody in infants. This antibody persists in the infants

till four to six months of age in same quantity from birth.
Afterwards it starts declining gradually from six months
till it completely disappears by 15 months.
But epidemiologically it has been seen that incidence of
measles is more common during nine to ten months of
That is why it is a satisfactorily compromise between 6
and 15 months of age, i.e. nine months.


Agent: Human herpesvirus type 6
Incubation period: 5 to 15 days
Communicable period: Unknown, but thought to

extend from the febrile stage to the time the rash

first appears
Source: Unknown
Transmission: Unknown

Sudden high (>38.8 C [>102 F]) fever of 3 to 5

days duration in a child who appears well,

followed by a rash (rose-pink macules that
blanch with pressure)
Rash appears several hours to 2 days after the
fever subsides and lasts 1 to 2 days.

Interventions: Supportive


Agent: Rubella virus
Incubation period: 14 to 21 days
Communicable period: From 7 days before to

about 5 days after rash appears

Source: Nasopharyngeal secretions; virus is also
present in blood, stool, and urine

Airborne or direct contact with infectious droplets
Indirectly via articles freshly contaminated with

nasopharyngeal secretions, feces, or urine


Low-grade fever
Pinkish red maculo papular rash that begins on

the face and spreads to the entire body within 1

to 3 days
Petechial red, pinpoint spots may occur on
the soft palate.

Clinical manifestations of Congenital Rubella

Fetal loss (spontaneous abortion and stillbirths)
Low birth weight

and central nervous system

Sensorineural deafness: unilateral or bilateral
Central auditory deafness
Mental retardation,
Speech defects, Autism

Patent ductus arteriosus (PDA)
Pulmonary arterial stenosis
Ventricular septal defects


Cataracts: pearly, dense, nuclear; 50 percent bilateral
Transient neonatal manifestations
Thrombocytopenia, +/- purpura
Late-emerging or developmental
Late-onset interstitial pneumonitis, 3-12 months
Chronic diarrhea
Insulin-dependent diabetes mellitus (type I)

Fig 4 German Measels

Use airborne droplet precautions if the child is

hospitalized; provide supportive treatment.

Isolate the infected child from pregnant women.

Rubella vaccines
If a woman in early pregnancy is found to have contacted rubella, medical

termination of pregnancy is indicated. The occurrence of such infection

may or may not be clinically evident. Confirmation can be obtained
through serological tests and through isolation of the virus.7
Serological tests
) Presence of rubella specific IgM indicative of recent infection.
) Four-fold rise in antibody titer over two serum samples collected 7 to
14 days apart, the first sample being taken as soon as possible (within
ten days of onset of suspected illness).
Isolation of virus
Antenatal infection of the fetus can be confirmed in the newborn by the
presence of specific IgM antibodies in the serum.


Agent: Paramyxovirus
Incubation period: 14 to 21 days
Communicable period: Immediately before and after

parotid gland swelling begins

Source: Saliva of infected person and possibly urine
Transmission: Direct contact or droplet spread from
an infected person

Headache and malaise
Jaw or ear pain aggravated by chewing, followed by

parotid glandular swelling

Orchitis may occur

Initial features are swelling of parotid gland obliterating the sulcus behind the ear

lobule; fever 37.8 to 38.3C for a day or so; and pain and tenderness in masseter
One and two days later, other parotid or salivary glands may become involved. The
degree of swelling, pain or discomfort may vary.
This usually reaches its peak about two days after the onset and subsides between four
to seven days. The parotid swelling extends from tip of the mastoid over the ramus of
mandibule forward to the cheek and downwards towards the neck, thus obliterating the
space between tip of the mastoid and angle of the mandibule.
Inability to feel the tip of the mastoid aids in differentiating between parotis and
cervical adenitis. During its prodrome, cowies sign first appears that is swelling and
outpouching of the openings of stenstens duct on the buccal mucosa opposite the third
upper molar.
Similarly the orifices of sublingual and submaxillary glands become swollen and
edematous. Leukocytosis occurs with an increase in lymphocytes.
Virus may be found in saliva, blood and cerebrospinal fluid.

Fig 6 Mumps

Institute airborne droplet precautions.
Provide bed rest until the parotid gland swelling

Avoid foods that require chewing.
Apply hot or cold compresses as prescribed to the neck.
Apply warmth and local support with snug fitting
underpants to relieve orchitis

Live mumps vaccines are available as monovalent mumps vaccine,

bivalent measlesmumps (MM) vaccine, and trivalent measles

mumpsrubella (MMR) vaccine.
Sorbitol and hydrolysed gelatin are used as stabilizers in mumps
vaccine, and neomycin is added as a preservative.
Once reconstituted, live attenuated mumps vaccines must be used
immediately or stored at 0 to 8C, kept away from light, and
discarded if not used within eight hours.
Vaccine may be administered 0.5 ml intramuscularly after one year of
age. There are very few contraindications to mumps vaccination.
Mumps vaccine should not be administered to individuals with
immune deficiency or immunosuppression;

Oophoritis and mastitis may occur in females; very rarely

Insulin dependent diabetes mellitus may occur
Aseptic meningitis
central nervous system is frequently infected
Meningitis5 and deafness6 are well recognized
complication of mumps.
Transient electrocardiogram abnormalities, mainly
changes in T waves and ST segments, have been reported
in up to 15 percent of cases; while rare case reports of fatal
nephritis or myocarditis have been published

Specific Bacterial Infections


Agent: Bordetella pertussis
Incubation period: 5 to 21 days (usually 10 days)
Communicable period: Greatest during the catarrhal

stage (when discharge from respiratory secretions

Source: Discharge from the respiratory tract of the
infected person
Transmission: Direct contact or droplet spread from
infected person; indirect contact with freshly
contaminated articles

Symptoms of respiratory infection followed by

increased severity of cough, with a loud whooping

May experience cyanosis, respiratory distress, and
tongue protrusion
Listlessness, irritability, anorexia

Catarrhal stage:
It lasts for five to ten days. The child has mild fever and

catarrh with irritating cough which is worse at night.

Paroxysmal stage:
This is characterized by bouts or paroxysms of cough. During each

bout, the child coughs five to ten times in rapid succession followed
by holding of breath, stimulation of respiratory center and forced
inspiration associated with a whooping sound.
This restores color and strength to the child exhausted by the bout of
The child may experience five to ten paroxysms per day.
The child may pass urine or stools during an attack of cough and may
bite his tongue.
Whooping cough may be complicated by occurrence of hernia, rectal
prolapsed and superadded pulmonary infection.
The paroxysmal stage may last for up to six weeks.

Convalescent stage
lasts for 12 weeks.

Confirmed (Laboratory Tests)

Isolation of Bordetella pertussis or detection of

genomic sequences by means of the polymerase

chain reaction
(PCR) or Positive paired serology.
It depends upon the recovery of the causative

organism from nasopharyngeal swab obtained

during the catarrhal and early paroxysmal stages.


Isolate child during the catarrhal stage; if the child is hospitalized,

institute airborne droplet precautions.
Administer antimicrobial therapy as prescribed.
Reduce environmental factors that cause coughing spasms, such
as dust, smoke, and sudden changes in temperature.
Ensure adequate hydration and nutrition.
Provide suction and humidified oxygen if needed.
Monitor cardiopulmonary status (via monitor as prescribed) and
pulse oximetry.
Infants do not receive maternal immunity


Agent: Corynebacterium diphtheriae
Incubation period: 2 to 5 days
Communicable period: Variable, until virulent bacilli are

no longer present (three negative cultures of discharge

from the nose and nasopharynx, skin, and other lesions);
usually 2 weeks, but can be 4 weeks
Source: Discharge from the mucous membrane of the
nose and nasopharynx, skin, and other lesions of the
infected person
Transmission: Direct contact with infected person,
carrier, or contaminated articles

WHO defined clinical conditions are associated with

increasing risk of toxin-induced systemic disease:
The catarrhal form (erythema of pharynx, no membranes),
The follicular form (patches of exudates over pharynx and

the tonsils),
The spreading form (membranes covering the tonsils and
posterior pharynx), and
The combined form (more than one anatomical site
involved, for example throat and skin)

Fig 7 Diphtheria pseudo membrane changes

Diagnostic evaluation

Schick test
It is done by giving 0.2 ml (1/50 MLD) of Schick

test antigen or toxin intradermally in one forearm,

and heated toxin in the other for control. As an
0.1 ml fluid diphtheria toxoid vaccine in 1:10
dilution may be injected intradermally.7 The arms
are inspected at 24 to 48 hours. The test is
interpreted as follows:

No reaction on either armNegative reaction. The person tested has enough antitoxin

(0.03 units per ml serum) to neutralize the antigen.

Test arm develops a circumscribed red flush, 1 to 5 cm in diameter, at 24 to 48 hours
while the control arm does not show any reactionPositive reaction. The flush is most
marked on the fourth day. It then fades, becomes brown and desquamates on 5th to 7th
day. A person with positive reaction is susceptible to diphtheria and needs
Both arms develop an equal flush, less circumscribed than in a positive caseFalse

positive reaction. The flush fades quickly and disappears by fourth day. This occurs
due to allergic reaction to the foreign protein in the toxin. The test is read as negative
and indicates adequate immunity.
Test arm shows true positive reaction and control arm shows false positive reaction

Combined reaction. Such a person is susceptible to diphtheria as well as allergic to the

antigen. He should be vaccinated cautiously, using very small but multiple doses.

Low-grade fever, malaise, sore throat, Dense pseudo

membrane formation of the throat that may interfere with

eating, drinking, and breathing.
Lymphadenitis, neck edema, bull neck
Laryngeal: It may be primary or secondary to faucial
diphtheria and is characterized by hoarseness, loss of
voice, croupy cough, and obstruction to breathing and
regression of chest wall, respiratory failure and death.
Infection may spread to trachea. It is the most fatal form.

Faucial: It is characterized by fever ranging from 37.8 to

38.3C, rapid pulse, enlarged cervical glands and spots of

exudate or false membrane on the pillars of fauces, tonsils
or pharynx. There may be bleeding if the membrane is
detached. There is little or no pain in the throat. High
fever 39.4 to 40C is uncommon in diphtheria and is more
suggestive of streptococcal infection. Fatality varies from
2 to 14 percent.

Anterior nasal: It is characterized by blood stained nasal

discharge and ulcers on the nose, upper lip and cheek. It is

a less toxic form of diphtheria.
Other forms: These are conjunctival and cutaneous
diphtheria in which the membrane forms on ulcers or
wounds. Membranous vulvovaginitis may occur in
children through common towels used in the nursery

Ensure strict isolation for the hospitalized child.
Administer diphtheria antitoxin as prescribed (after a skin

or conjunctival test to rule out sensitivity to horse serum).

Provide bed rest.
Administer antibiotics as prescribed.
Provide suction and humidified oxygen as needed.
Provide tracheostomy care if a tracheostomy is necessary..
Foul-smelling, mucopurulent nasal discharge


Tuberculosis is a contagious disease caused by Mycobacterium

tuberculosis, an acid-fast bacillus

Multidrug-resistant strains of M. tuberculosis occur because of child
or family noncompliance with therapeutic regimens.
The route of transmission of M. tuberculosis is through inhalation of
droplets from an individual with active tuberculosis.
There is an increased incidence in urban lowincome areas, nonwhite
racial or ethnic groups, and first-generation immigrants from
endemic countries.
Most children are infected by a family member or by another
individual with whom they have frequent contact, such as a

It is 4 to 12 weeks from infection to primary lesion,

but from infection to disease it may be years. The

chances of getting the disease are more during first 6
to 24 months of life.

Race: Caucasian (which includes most Indians) and Mongoloid races

have a distinct natural resistance to tuberculosis compared to Africans,

American Indians and Eskimos.
Age: Children under two are most susceptible to new infection.
Sex: Prevalence of tubercular disease is higher in males than in females
at all ages
Malnutrition: Extreme malnutrition or general debility would certainly
make a person more prone to tuberculosis or any other infective disease.
Specific immunity: It is acquired through primary subclinical infection
or BCG vaccination and provides Good protection against the disease.

Environment Factors
Housing: Chances of repeated and massive doses of

infection are more when people live in dark, illventilated,

overcrowded houses. As a result, the risk of developing
tuberculosis is increased.
Social factors: Transmission of tuberculosis is favored by
large family size, poverty, ignorance about the mode of
spread and occupational environment

Child may be asymptomatic or develop symptoms

such as malaise, fever, cough, weight loss, anorexia,

and lymphadenopathy.
Specific symptoms related to the site of infection,
such as the lungs, brain, or bone, may be present.
With increased time, asymmetrical expansion of the
lungs, decreased breath sounds, crackles, and
dullness to percussion develop.

The characteristic lesion is the tubercle, a nodular

collection of epitheliod cells, giant cells and tubercle

bacilli in the center, surrounded by lymphocytes and
Adjacent tubercles enlarge and coalesce to form a
There is central necrosis, caseation, tissue
destruction and peripheral spread. Healing takes
place by fibrosis and calcification.
Destruction and healing frequently coexist.

Fig 8 Tuberculosis Pathogenesis

Mantoux test
The test produces a positive reaction 2 to 10 weeks after the initial

The test determines whether a child has been infected and has
developed sensitivity to the protein of the tubercle bacillus; a
positive reaction does not confirm the presence of active disease
(exposure versus presence).
After a child reacts positively, the child will always react positively;
a positive reaction in a previously negative child indicates that the
child has been infected since the last test.
Tuberculosis testing should not be done at the same time as measles
immunization (viral interference from the measles vaccine may
cause a false-negative result).

Mantoux test Interpretation

Induration measuring 15 mm or more is considered to be a

positive reaction in children 4 years or older who do not

have any risk factors.
Induration measuring 10 mm or more is considered to be a
positive reaction in children younger than 4 years and in
children with chronic illness or at high risk for exposure to
Induration measuring 5 mm or more is considered to be
positive for the highest risk groups, such as children with
immunosuppressive conditions or human immunodeficiency
virus infection.

Diagnostic evaluation

A definitive diagnosis is made by showing the presence

of mycobacteria in a culture.
Chest x-rays are supplemental to sputum cultures and are
not definitive alone.
Because an infant or young child often swallows sputum
rather than expectorates it, gastric washings (aspiration of
lavaged contents from the fasting stomach) may be done
to obtain a specimen; the specimen is obtained in the early
morning before breakfast.


A 9-month course of isoniazid (INH) may be prescribed to

prevent a latent infection from progressing to clinically

active tuberculosis and to prevent initial infection in
children in high-risk situations; a 12-month course may be
prescribed for a child infected with human
immunodeficiency virus (HIV).
Recommendation for a child with clinically active
tuberculosis may include combination administration of
isoniazid, rifampin (Rifadin), and pyrazinamide daily for 2
months, and then isoniazid and rifampin twice weekly for 4

Place children with active disease who are contagious on

respiratory isolation until medications have been initiated,

sputum cultures show a diminished number of organisms,
and cough is improving
Stress the importance of adequate rest and adequate diet.
Instruct the child and family about measures to prevent
the transmission of tuberculosis.
Case finding and follow-up with known contacts is
crucial to decrease the number of cases of individuals
with active tuberculosis.


Description: An acute or chronic inflammation of the liver

that may be caused by a virus, a medication reaction, or

another disease process.

Hepatitis A (HAV)
Highest incidence of HAV infection occurs among

preschool or school-age children younger than 15 years.

Many infected children are asymptomatic, but mild
nausea, vomiting, and diarrhea may occur.
Infected children who are asymptomatic still can spread
HAV to others.

Hepatitis B (HBV)
Most HBV infection in children is acquired perinatally.
Newborn infants are at risk if the mother is infected with HBV or was a carrier

of HBV during pregnancy.

Possible routes of maternal-fetal (infant) transmission include leakage of the
virus across the placenta late in pregnancy or during labor, ingestion of
amniotic fluid or maternal blood, and breast-feeding, especially if the mother
has cracked nipples.
The severity in the infant varies from no liver disease to fulminant (severe
acute course) or chronic active disease.
In children and adolescents, HBV occurs in specific high-risk groups,
including children with hemophilia or other disorders requiring multiple blood
transfusions, children or adolescents involved in IV drug abuse,
institutionalized children, preschool children in endemic areas, and children
who have had heterosexual activity or sexual activity with homosexual men.
Infection with HBV can cause a carrier state and lead to eventual cirrhosis or
hepatocellular carcinoma in adulthood.

Hepatitis C (HCV)
Transmission of HCV is primarily by the parenteral

Some children may be asymptomatic, but HCV often
becomes a chronic condition and can cause cirrhosis
and hepatocellular carcinoma.

Hepatitis D
Infection occurs in children already infected with

Acute and chronic forms tend to be more severe than
HBV and can lead to cirrhosis.
Children with hemophilia are more likely to be
infected, as are children who are IV drug users.

Hepatitis E
Infection is uncommon in children.
Infection is not a chronic condition, does not cause

chronic liver disease, and has no carrier state.

Hepatitis G
Hepatitis G virus is blood-borne and is similar to

High-risk groups include transfusion recipients, IV
drug users, and individuals infected with HCV.
Individuals are often asymptomatic, and most
infections are chronic.

Fig 9 Hepatitis changes in liver

Prodromal or Anicteric Phase
Lasts 5 to 7 days
Absence of jaundice
Anorexia, malaise, lethargy, easy fatigability
Fever (especially in adolescents)
Nausea and vomiting
Epigastric or right upper quadrant abdominal pain
Arthralgia and rashes (more likely with hepatitis B virus)
Icteric Phase
Jaundice, which is best assessed in the sclera, nail beds, and mucous membranes
Dark urine and pale stools

Immunoglobulin provides passive immunity and

may be effective for pre-exposure prophylaxis to

prevent HAV infection.
Hepatitis B immunoglobulin provides passive
immunity and may be effective in preventing
infection after a one-time exposure (should be given
immediately after exposure
Hepatitis A vaccine and hepatitis B vaccine
Proper hand washing and standard precautions can
prevent the spread of viral hepatitis.

Strict hand washing is required.
Hospitalization is required in the event of coagulopathy or fulminant hepatitis.
Standard precautions and enteric precautions are followed during hospitalization.
Provide enteric precautions for at least 1 week after the onset of jaundice with

The hospitalized child usually is not isolated in a separate room unless he or she is
focally incontinent and items are likely to become contaminated with feces.
Children are discouraged from sharing toys.
Instruct the child and parents in effective hand washing techniques.
Instruct the parents to disinfect diaper-changing surfaces thoroughly with a
solution of 1/4 cup bleach in 1 gallon of water.
Maintain comfort, and provide adequate rest and sleep.
Provide a low-fat, well-balanced diet.
Inform the parents that because HAV is not infectious 1 week after the onset of
jaundice, the child may return to school at that time if he or she feels well enough.
Inform the parents that jaundice may appear worse before it resolves.


Agent: Enteroviruses
Incubation period: 7 to 14 days
Communicable period: Unknown; the virus is present in

the throat and feces shortly after infection and persists

for about 1 week in the throat and 4 to 6 weeks in the
Source: Oropharyngeal secretions and feces of the
infected person
Transmission: Direct contact with infected person;
fecal-oral and oropharyngeal routes

Fever, malaise, anorexia, nausea, headache, sore

Abdominal pain followed by soreness and
stiffness of the trunk, neck, and limbs that may
progress to central nervous system paralysis

Fig 10 poliomyelitis changes


Abortive polio
Occurs in 4 to 8 percent of infections and is

characterized by minor illness with low grade fever,

malaise, sore throat, vomiting, abdominal pain, and loss
of appetite.
Recovery is rapid and complete, there is no paralysis. It
cannot be distinguished from other viral infections
causing mild respiratory tract or gastrointestinal

Nonparalytic aseptic meningitis

Occurs in 1 to 2 percent of infections and is characterized

by headache, neck, back and leg stiffness several days

after a prodrome similar to abortive polio.
Cases recover within 2 to 10 days.
It cannot be distinguished from other causes of aseptic
Illness may reach imminent paralysis but soon reverts

Paralytic poliomyelitis:
Symptoms often occur in two phases, minor and major and are often separated

by several days without symptoms. Minor phase consists of symptoms similar to

those of abortive poliomyelitis. The major phase of illness begins with muscle
pain, spasms and the return of fever. This is followed by rapid onset of flaccid
paralysis that is usually complete within 72 hours.
a) Spinal form: This is probably the most common form of paralytic muscles is

asymmetrical and the extent of paralysis is variable. Paralytic manifestation in

extremities begin proximally and progress to involve distal muscle groups
b) Bulbar and bulbospinal forms: These account for only 10 percent cases of
paralytic poliomyelitis and are usually life threatening. Pure bulbar form is
rare. Pure bulbar form is rare and results from a cranial nerve lesion, resulting
in respiratory insufficiency and difficulty in swallowing, eating or speaking.
c) Encephalitic form: The child may be irritable, delirious, disoriented or
stuperose and may have convulsions.

Enteric precautions
Supportive treatment
Bed rest
Monitoring for respiratory paralysis
Physical therapy

Complete bed rest in; comfortable but rotating positions should
be maintained in a polio bed: firm mattress, footboard, sponge
rubber pads or rolls, sandbags, and light splints, massage or
intramuscular injection is contraindicated during the acute phase
Correct positioning of affected limbs,
Passive movements and physiotherapy of the joints after the
acute phase subsides,
Warm water fomentation,
Symptomatic treatment for fever and pain,
Have to report immediately if there is progression of paralysis
Orthopedic surgery for deformities or contractures.


Routine immunization: This is carried out as per national Immunization

Supplementary immunization activity (SIA):
NID (National Immunization Day): the entire country is covered with OPV.
SNID ( Sub National Immunization Day): some states or parts of states are
Mop up immunization: final end game strategy; when wild virus
transmission is very much focal
Surveillance of acute flaccid paralysis (AFP):
This is done to identify areas of wild polio virus transmission and to guide
immunization activities accordingly


Agent: Group A beta-hemolytic streptococci
Incubation period: 1 to 7 days
Communicable period: About 10 days during the

incubation period and clinical illness; during the first 2

weeks of the carrier stage, although may persist for months
Source: Nasopharyngeal secretions of infected person and
Transmission: Direct contact with infected person or
droplet spread; indirectly by contact with contaminated
articles, ingestion of contaminated milk, or other foods

Abrupt high fever, flushed cheeks, vomiting, headache, enlarged lymph

nodes in the neck, malaise, abdominal pain

A red, fine sandpaper-like rash develops in the axilla, groin, and neck that
spreads to cover the entire body except the face.
Rash blanches with pressure (Schultz-Charlton reaction) except in areas of
deep creases and folds of the joints (Pastias sign).
Desquamation, sheet-like sloughing of the skin on palms and soles, appears
by weeks 1 to 3.
The tongue is initially coated with a white, furry covering with red
projecting papillae (white strawberry tongue); by the third to fifth day, the
white coat sloughs off, leaving a red swollen tongue (red strawberry tongue).
Tonsils are reddened, edematous, and covered with exudates.
Pharynx is edematous and beefy red.

Institute respiratory precautions until 24 hours after

initiation of antibiotic therapy.

Provide supportive therapy.
Provide bed rest.
Encourage fluid intake


Agent: Human parvovirus B19
Incubation period: 4 to 14 days; may be 20 days
Communicable period: Uncertain, but before the

onset of symptoms in most children

Source: Infected person
Transmission: Unknown; possibly respiratory
secretions and blood

Before rash: Asymptomatic or mild fever, malaise,

headache, runny nose

Stages of rash
i. Erythema of the face (slapped-cheek appearance)
develops and disappears by 1 to 4 days.
ii. About 1 day after the rash appears on the face,
maculopapular red spots appear, symmetrically
distributed on the extremities; the rash progresses from
proximal to distal surfaces and may last a week or more.
)The rash subsides, but may reappear if the skin becomes
irritated by the sun, heat, cold, exercise, or friction.

Child is not usually hospitalized.
Pregnant women should avoid the infected individual.
Provide supportive care. Administer antipyretics,

analgesics, and anti-inflammatory medications as



1. Agent: Epstein-Barr virus
2. Incubation period: 4 to 6 weeks
3. Communicable period: Unknown
4. Source: Oral secretions
5. Transmission: Direct intimate contact

1. Fever, malaise, headache, fatigue, nausea, abdominal
pain, sore throat, enlarged red tonsils
2. Lymphadenopathy and hepatosplenomegaly
3. Discrete macular rash most prominent over the trunk
may occur.

1. Provide supportive care.
2. Monitor for signs of splenic rupture


H1N1 is also known as swine flu and is a strain of

It is a viral infection that affects the respiratory system
and is highly contagious.
Children, pregnant women, persons with preexisting
health conditions, and persons with a compromised
immune system are at high risk for developing
It is caused by contact with an infected person or by
touching something such as a toy or tissue that the
infected person has touched.

H1N1 flu vaccine

Children age 6 months and older need to be vaccinated.

ii. Children younger than 6 months are not old enough to
receive the vaccine; family members and caregivers need to
get vaccinated.
iii. Children 9 years and younger need two doses at least 3
weeks apart; children 10 years and older need one dose (it
takes about 2 weeks after receiving the second dose or the
first dose in children needing only one dose before immunity
)The H1N1 vaccine and seasonal flu vaccine can be given at the
same time.

A nasal spray version of the H1N1 vaccine that

contains a weakened live virus may be given to

people 2 to 49 years old who do not have a chronic
health condition.
Wash the childs hands frequently and teach
handwashing techniques.
Avoid children who are ill.
Keep the child home from school or away from
others until the child has been fever-free (without
the use of antipyretics) for at least 24 hours.



Actions to Take When Administering a Parenteral Vaccine

Verify the prescription for the vaccine.

Obtain an immunization history from the parents and assess for allergies.
Provide information to the parents about the vaccine.
Obtain parental consent.
Check the lot number and expiration date and prepare the injection.
Select the appropriate site for administration.
Administer the vaccine.
Document the administration and site of administration and lot number
and expiration date of the vaccine.
Provide a vaccination record to the parents.

The nurse should first verify the prescription and then obtain an immunization history

from the parents to ensure that the immunizations are up to date.

The nurse should also question the parents about the presence of any allergies in the
child because some vaccines contain components to which the child may be allergic.
The nurse next provides information to the parents about the vaccine and obtains
The expiration date and the lot number (located on the medication vial) of the vaccine
should be checked before preparing the vaccine for administration.
When the vaccine is prepared, the nurse prepares the child for the procedure, selects an
appropriate site, and administers the vaccine.
The nurse documents that the vaccination has been administered and provides an
updated immunization record to the parents.
If there is suspicion that the parent will not bring the child to the pediatrician or health
care clinic for follow-up immunizations according to the optimal immunization
schedule, any of the recommended vaccines can be administered simultaneously.

General contraindications and precautions

A vaccine is contraindicated if the child experienced

an anaphylactic reaction to a previously

administered vaccine or a component in the vaccine.
Live virus vaccines generally are not administered to
individuals with severely deficient immune systems,
individuals with a severe sensitivity to gelatin, or
pregnant women.
A vaccine is administered with caution to an
individual with a moderate or severe acute illness,
with or without fever.


Hepatitis B vaccine (HepB)

Protects against hepatitis B
Administered by the intramuscular route
First dose of hepatitis B vaccine (monovalent) should be administered soon after birth and

before hospital discharge

Monovalent HepB or a combination vaccine containing hepatitis B may be used to complete
the series.
The second dose is administered at age 1 to 2 months.
The final dose should be given at 24 weeks or older (6 to 18 months of age).
Contraindications: Severe allergic reaction to previous dose or vaccine component
(components include aluminum hydroxide, yeast protein)
Precautions: An infant weighing less than 2000 g or an infant with moderate or severe acute
illness with or without fever.
HBsAg-positive mothers
Infant should receive HepB vaccine and hepatitis B immunoglobulin (HBIG) within 12
hours of birth.
Infant should be tested for HBsAg and antibody to HBsAg after completion of HepB series
(9 to 18 months of age).

Two vaccines are available (RotaTeq and

They are administered by the oral route because the vaccine must

replicate in the infants gut.

Vaccine may be withheld if an infant is experiencing severe vomiting
and diarrhea; it is administered as soon as the infant recovers.
RotaTeq: Three doses are needed; the first dose of the vaccine needs
to be administered at age 6 to 14 weeks, the second is given 4 to 10
weeks after the first dose, and the third is given 4 to 10 weeks after
the second dose (no later than 32 weeks of age).
Rotarix: Two doses are needed; the first dose of the vaccine needs to
be administered at age 6 to 14 weeks, and the second is given 4
weeks after the first dose (series needs to be completed by 24 weeks
of age).

Diphtheria, tetanus, acellular pertussis (DTaP); tetanus

toxoid; reduced diphtheria toxoid and acellular pertussis
vaccine (Tdap adolescent preparation)

against diphtheria, tetanus, and pertussis

Administered by intramuscular route
DTaP is administered at 2, 4, and 6 months; between 15 and 18 months; and between 4 and 6
years of age.
The fourth dose of DTaP can be given at 12 months of age if 6 months have elapsed since the
third dose and the child might not return for follow-up at 12 to 18 months of age.
The fifth (final) dose is administered at age 4 years or older.
The Tdap (adolescent preparation) is recommended at 11 to 12 years of age for children who
have completed the recommended childhood DTaP series but have not received a tetanus and
diphtheria toxoid (Td) booster dose; children 13 to 18 years old who have not received Tdap
should receive a dose.
Td does not provide protection against pertussis; Td is used as a booster every 10 years after
Tdap is administered at 11 to 18 years of age.
Encephalopathy is a complication.
Contraindications: Encephalopathy within 7 days of a previous dose or a severe allergic
reaction to a previous dose or to a vaccine component.

Haemophilus influenzae type b conjugate vaccine (Hib)

Protects against numerous serious infections caused by H. influenzae type

b, such as bacterial meningitis, epiglottitis, bacterial pneumonia, septic

arthritis, and sepsis
Administered by intramuscular route
Hib is administered at 2, 4, and 6 months of age and between 12 and 15
months of age.
Depending on the brand of Hib vaccine used for the first and second doses,
a dose at 6 months of age (third dose) may not be needed.
DTaP-Hib combination products should not be used for primary
immunization in infants at 2, 4, or 6 months of age, but can be used as the
final dose in children 12 months to 4 years of age.
Contraindications: Severe allergic reaction to a previous dose or vaccine

Inactivated poliovirus vaccine (IPV)

IPV protects against polio.
IPV is administered by the subcutaneous route (may also be

given by the intramuscular route)

IPV is administered at 2, 4, and 6 to 18 months and 4 to 6
years of age.
The last dose of the IPV should be administered on or after
age 4 years and at least 6 months after the previous dose;
additionally, if four doses are administered before age 4 years,
a fifth dose should be administered at age 4 to 6 years.
Contraindications: Severe allergic reaction to a previous dose
or vaccine component; components may include formalin,
neomycin, streptomycin, or polymyxin B

Measles, mumps, rubella (MMR) vaccine

MMR protects against measles, mumps, and rubella.
Vaccine is administered by the subcutaneous route.
The first dose of MMR is administered between 12 and 15 months of age; the

second dose is recommended at 4 to 6 years of age (the second dose may be

administered during any visit as long as at least 4 weeks have elapsed since
the first dose).
Children who have not received the second dose previously should complete
the schedule at the 11- to 12-year-old pediatric or health care clinic visit.
Contraindications: Severe allergic reaction to a previous dose or vaccine
component (gelatin, neomycin, eggs), pregnancy, known immunodeficiency
If the child received immunoglobulin, the MMR vaccine should be
postponed for at least 3 to 6 months (immunoglobulin can inhibit the
immune response to the MMR vaccine).

Varicella vaccine
Varicella vaccine protects against chickenpox.
It is administered by the subcutaneous route.
Varicella vaccine is administered at 12 and 15 months of age

and again at 4 to 6 years of age.

Children 13 years old and older (who have not had chickenpox
or have not been previously vaccinated) need two doses given
at least 28 days apart.
Children receiving the vaccine should avoid aspirin or aspirincontaining products because of the risk of Reyes syndrome.
Contraindications: Severe allergic reaction to a previous dose
or vaccine component (gelatin, bovine albumin, neomycin),
significant suppression of cellular immunity, pregnancy

Pneumococcal conjugate vaccine (PCV)

PCV prevents infection with Streptococcus pneumoniae, which may cause

meningitis, pneumonia,septicemia, sinusitis, and otitis media.

It is administered by the intramuscular route.
Vaccine can be given concurrently with other childhood vaccines at 2, 4, 6, and 12
to 15 months of age (the final dose in the series is given at age 12 months or older).
Pneumococcal polysaccharide vaccine (PPSV) is recommended in addition to PCV
for certain high-risk groups, such as children with chronic illness specifically
associated with increased risk of pneumococcal disease or its complications;
anatomical or functional asplenia; hemoglobinopathies; nephrotic syndrome;
cerebrospinal fluid leaks; a cochlear implant; and conditions associated with
immunosuppression (PPSV is given at least 8 weeks after the last dose of PCV).
Contraindications: Severe allergic reaction to a previous dose or vaccine

Hepatitis A vaccine (HepA)

Vaccine protects against hepatitis A.
Vaccine is recommended for all children at age 1 year

(12 to 23 months); two doses should be administered

at least 6 months apart (vaccination of children older
than 23 months is allowed for those at increased
It is administered by the intramuscular route.
Contraindications: Severe allergic reaction to a
previous dose or vaccine component

Meningococcal vaccine (MCV)

Vaccine protects against Neisseria meningitidis.
Meningococcal (MCV4) vaccine is the preferred type of vaccine and is

given intramuscularly.
MCV4 should be administered to all children at age 11 to 12 years and
to unvaccinated adolescents at high school entry (age 15 years); all
college freshman living in dormitories should be vaccinated.
Revaccination is recommended for children who remain at increased
risk after 3 years (if the first dose was administered at age 2 to 6
years) or after 5 years (if the first dose was administered at age 7
years or older).
It is contraindicated in children with a history of Guillain-Barre

Guidelines for Administration of Vaccines

Follow manufacturers recommendations for route of administration, storage, and

reconstitution of the vaccine.

If refrigeration is necessary, store on a center shelf and not on the door; frequent
temperature changes from opening the refrigerator door can alter the vaccines
A vaccine information statement needs to be given to the parents or individual, and
informed consent for administration needs to be obtained.
Check the expiration date on the vaccine bottle. Parenteral vaccines are given in
separate syringes in different injection sites.
Vaccines administered intramuscularly are given in the vastus ateralis muscle (best
site) or ventrogluteal muscle (the deltoid can be used for children 36 months and
older); the dorsogluteal site (buttocks) is avoided.
Vaccines administered subcutaneously are given into the fatty areas in the lateral
upper arms and anterior thighs.
Adequate needle length and gauge are as follows: intramuscular, inch, 23-25 gauge;
subcutaneous, inch, 5 gauge (needle length may vary depending on the childs size).

Mild side effects include fever, soreness, swelling, or redness at injection

site. A topical anesthetic may be applied to injection site before the

For painful or red injection sites, advise the parent to apply cool
compresses for the first 24 hours, and then use warm or cold compresses as
long as needed.
An age-appropriate dose of acetaminophen (Tylenol) or ibuprofen (Motrin)
may be administered every 4 to 6 hours for vaccine-associated discomfort.
Maintain an immunization recorddocument day, month, year of
administration; manufacturer and lot number of vaccine; name, address,
title of person administering the vaccine; and site and route of
A vaccine adverse event report needs to be filed and the health department
needs to be notified if an adverse reaction to an immunization occurs.


Local reactions
Tenderness, erythema, swelling at injection site
Low-grade fever
Behavioral changes such as drowsiness, unusual

crying, decreased appetite

Minimizing local reactions
Select a needle of adequate length to deposit vaccine
deep into the muscle or subcutaneous mass.
Inject into the appropriate recommended site

Anaphylactic reactions
Goals of treatment are to secure and protect the airway, restore

adequate circulation, and prevent further exposure to the antigen.

for a mild reaction with no evidence of respiratory distress or
cardiovascular compromise, a subcutaneous injection of an
antihistamine, such as diphenhydramine (Benadryl), and
(Adrenalin) may be administered.
Formoderate or severe distress, establish an airway; provide
cardiopulmonary resuscitation if the child is not breathing;
elevate the head; administer epinephrine, fluids, and
vasopressors as prescribed; monitor vital signs; and monitor
urine output.

Communicable diseases spread from one person to

another or from an animal to a person. The spread often

happens via airborne viruses or bacteria, but also through
blood or other bodily fluid. The terms infectious and
contagious are also used to describe communicable
disease. In this section, learn about coordinated efforts to
combat a few of the most serious communicable diseases
on a global level. The following infections Nonspecific
viral infection, Specific viral infections, Nonspecific
bacterial infections, Specific bacterial infections. And
with complete immunization we can keep the child safe.


So today we have studied all the different types of communicable diseases

and we understand all the nursing responsibility in communicable

diseases. A convenient method is to classify communicable diseases
according to the mode of transmission. Such classification facilitates the
control of these diseases because transmission is the most vulnerable part
in the chain of spread. The measures of prevention and control, in
general, are similar for diseases in the same group. It is often difficult to
tackle the host, i.e. the man. It is again relatively difficult to tackle the
causative agent at the source since the source, in most cases is the man
himself. In practice, one finds it comparatively easier to attack the agent
in the environment in relation to the vehicle of transmission. In this
background, communicable diseases are grouped into airborne or
respiratory infections, water and food-borne or intestinal infections,
contact or surface infections and arthropod-borne infections.