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 daysweeks 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:

Correct Information

Vaccine-preventable
diseases have been
eliminated

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

Parental Misconceptions
Misconception:

Correct Information

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

Childs immune system

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

Parental Misconceptions
Misconception:

Correct Information

Vaccines may cause

serious conditions,
such as autism

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 lacelike 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 2nd 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 3rd day: parotitis (enlarged parotid gland),
unilateral or bilateral, pain, tenderness

Diagnosis and
Management
Diagnosis by classic presentation, serum antibody
testing 1 month after infection
Treatment:
analgesics for pain
antipyretics
Isolation
Bed rest
Soft diet
Cold compress to neck

Rubella
(German measles)
Viral Infection
Vaccine Available R in MMR
Transmitted by direct contact of
nasopharyngeal secretions, feces, urine,
or articles freshly contaminated
Communicable 7 days before to 5 days
after rash

Symptoms
Rash on face which rapidly spreads downward to neck,
arms, trunk and legs
by end of first day body is covered with pinkish-red
maculopapules
Rash disappears in same order as it appeared
Rash gone by 3rd day
also low grade fever, HA, Malise, cough, sore throat

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 inspir
ation 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 4th or 5th day white coat sloughs off

leaving prominent papillae = red
strawberry tongue
Rash: red, pin head sized lesions, rash
is intense in folds and joints, flushed
cheeks

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.
2.
3.
4.

Rubeola
Rubella
Roseola
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