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Communicable Disease. Communicable Diseases Diseases with high transmission rates transmitted by contact with body fluids directly transmitted- acquired.

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Presentation on theme: "Communicable Disease. Communicable Diseases Diseases with high transmission rates transmitted by contact with body fluids directly transmitted- acquired."— Presentation transcript:

1 Communicable Disease

2 Communicable Diseases Diseases with high transmission rates transmitted by contact with body fluids directly transmitted- acquired from a person or vector indirectly transmitted- contact with contaminated objects Viruses are the leading cause of most pediatric communicable diseases

3 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

4 IMMUNIZATIONS

5 Why Immunize?  We are a mobile society  Diseases do not stop at geopolitical borders  Children in the United States continue to get diseases that are vaccine preventable  There continues to be newly emerging and re-emerging infectious diseases  Healthy People 2020 goal to have 100% elimination of vaccine preventable diseases

6 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

7 Advisory Committee for Immunization Practices (ACIP)  Sets the recommended schedule for immunizations  Infants and Children 0-6  Children and Adolescents 7-18  Catch-up schedules (1 month behind)  Schedule is reviewed yearly to reflect current recommendations for licensed vaccines.

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9 Children 0-23 months  DTaP (4 doses)  Hib (4 doses)  PCV (4 doses)  Hep B (3 doses)  IPV ( 3 doses)  Hep A (2 doses)  Influenza (2 doses yearly)  MMR (1 dose)  Varicella (1 dose)  Up to 24 injections in 2 years  As many as 5 injections in a single visit

10 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)

11 Side Effects  All vaccines could produce side effects  CDC publishes Vaccine Information Sheets (VIS)  Most side effects are minor and are related to the administration, not the vaccine  Soreness and swelling at injection site  Low-grade fever

12 Contraindications  Severe allergic reaction (anaphylaxis) after a previous dose or to a vaccine component  Encephalopathy not attributable to another identifiable cause within 7 days of administration  Pregnancy (live vaccines)  Severe immunodeficiency (live vaccines)

13 Adverse Events  Vaccine Adverse Event Reporting System (VAERS)  Detect new, unusual, or rare vaccine adverse events  Monitor increases in known adverse events  Identify potential patient risk factors for particular types of adverse events  Identify vaccine lots with increased numbers or types of reported adverse events  Assess the safety of newly licensed vaccines

14 Vaccine Information Statements (VIS)  National Childhood Vaccine Injury Act of 1986  Law states parents/legal guardians must be informed about the benefits and risks of vaccines before administration  Legal mandate VIS must be offered electronically or paper copy  The law requires providers to use those developed by CDC (do not change a VIS or make your own VIS)

15 Vaccine Information Statements (VIS)  National Childhood Vaccine Injury Act of 1986  Law states parents/legal guardians must be informed about the benefits and risks of vaccines before administration  Legal mandate VIS must be offered electronically or paper copy  The law requires providers to use those developed by CDC (do not change a VIS or make your own VIS)

16 Informed Consent  Parent or legal representative sign a separate “informed consent” form if it is required by state  VISs are not informed consent forms

17 Safe Storage and Handling  Store vaccines at the recommended temperatures according to the manufacturer’s guidelines IMMEDIATELY upon arrival  Vaccine shipments should be delivered when staff is available to unpack and store the vaccine properly  Store vaccine in storage units designated specifically for biologics  Post “Do Not Unplug” signs next electrical outlets

18 Safe Storage and Handling  Prepare vaccines at the time the vaccine is administered  Reconstitute immediately prior to injection  Store diluent according to the manufacturer’s instructions

19 Atraumatic care Select needle of adequate length-longer needles inserted at 90 degrees is best Select proper site VL infants Deltoid > 18 months Minimize pain EMLA cream Distraction

20 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

21 COMMUNICABLE DISEASES

22 Communicable Disease Viral or Bacterial Most are transmitted by respiratory secretions in early prodromal period Communicable disease can cause serious complications and death Infected children can transmit disease to pregnant women and cause fetal disease, disability Many are Diseases are Vaccine Preventable

23 Nursing Responsibilities Assessment Identify recent exposure Identify prodromal symptoms symptoms that occur early in disease Locate immunization history Confirm history of having the disease

24 Nursing Responsibilities Implementation prevent spread-isolation reduce risk of cross contamination prevent complications provide comfort

25 VIRAL INFECTIONS

26 Viral Infections Non- Preventable Viral Disease Fifth’s Disease Roseola Vaccine Preventable Viral Disease Varicella Ruebola Mumps Rubella

27 FIFTH’S DISEASE Parvovirus

28 Fifth’s Disease Affects any age child, usually preschool or early school age Common disease as no vaccine is available Believed once had disease will not acquire again Moderately uncomfortable symptoms

29 Symptoms No prodromal symptoms Begins with rash of erythema on cheeks “slapped face appearance”-classic for fifth disease Next 24 hrs high fever, lethargy, n/v, abd. pain, cervical lympadnopathy

30 Symptoms Within the week, maculopapular red spots appear Symmetrically on upper and lower extremities has a lace- like appearance Rash subsides in a few days but reappears if skin is irritated (sun, heat, cold)

31 Management Management of other symptoms (fever, pain, nausea, vomiting) Explain the stages of rash development to parents Isolation during facial rash stage The immune-competent child can return to school or daycare once the body rash has appeared

32 ROSEOLA

33 Roseola Disease of younger children Common disease as no vaccine is available Rarely affects children >3 years Believed once had disease will not acquire again No uncomfortable symptoms except for high fever

34 Symptoms Prodromal Symptoms of persistent high fever for 3-4 days in a child who appears well Then drop in fever to normal and rash appears that identifies roseola Rash is a rose-pink macules first on trunk, spread to neck, face, extremities, not itchy, lasts 1-2 days

35 Management Antipyretics, analgesics Isolation not necessary once rash appears Since fever is very high can have febrile seizures

36 VARICELLA (Chicken Pox)

37 Varicella Affects unvaccinated child of any age Vaccine available for children age 12 months and older Extremely uncomfortable disease that lasts for weeks Death is rare but can be caused by blockage of GI track, especially in infants and immunocompromised children

38 Symptoms Prodromal period slight fever, malaise, anorexia Next 24 hours highly itchy rash primarily over trunk can spread all over skin and mucus membranes, GI track, genitalia The key to diagnosis is varying stages of rash

39 Symptoms Rash 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 macule papule vesicle

40 Management Communicable 1 day before eruption of vesicles to 6 days after first crop of vesicles have formed 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, skin care (extremely itchy rash) Treat secondary complications (bacterial infections from scratching)

41 RUBEOLA Measles

42 Rubeola Affects unvaccinated children of any age Vaccine available for children age 12 months and older (First “M” in MMR) Extremely uncomfortable disease that lasts for weeks Death is common especially in infants and immune- compromised children as many cases spread to brain and cause encephalitis

43 Symptoms Prodromal period in first 24 hours Fever, malaise, cough, coryza, conjunctivitis Next 48 hours first ‘rash’ that identifies rubeola “Koplik spots” (small, irregular, red spots with minute bluish-white center) first seen on buccal mucosa

44 Symptoms Raised erythema rash on face that spreads downward Discrete, then turns confluent on the third day Other respiratory symptoms persist

45 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

46 MUMPS

47 Mumps Affects unvaccinated children of any age Vaccine available for children age 12 months and older (Second “M” in MMR) Moderately uncomfortable disease Death is not common however swelling causes extreme difficulty to swallow, leads to dehydration

48 Mumps Prodromal symptoms of fever, headache, maliase, anorexia, and earache aggravated by chewing On 3 rd day classic symptoms of parotitis (enlarged parotid gland), unilateral or bilateral, pain, tenderness No rash

49 Management Analgesics for pain Antipyretics Isolation until swelling resolves Bed rest Soft diet Cold compress to neck

50 RUBELLA German Measles

51 Rubella Affects unvaccinated children of any age Vaccine available for children age 12 months and older (“R” in MMR) Mildly uncomfortable disease Death is not common

52 Symptoms Prodromal symptoms of low grade fever, HA, malaise, cough, sore throat Identifiable rash begins on face which rapidly spreads downward to neck, arms, trunk and legs By end of first day body is covered with pinkish-red maculopapules Slightly itchy Rash disappears in same order as it appeared gone by 3 rd day

53 Management Antipyretics Comfort measures-slight itchy rash Isolation until rash disappears Avoid contact with pregnant women

54 BACTERIAL INFECTIONS

55 Bacterial Infections Vaccine Preventable Bacterial Disease Diphtheria Pertussis Vaccine Preventable Bacterial Disease Scarlet Fever

56 DIPHTHERIA

57 Diphtheria Affects unvaccinated children of any age Vaccine available for children age 2 months and older (“D” in Dtap) Serious respiratory involvement Death is common due to airway obstruction from laryngeal swelling

58 Symptoms yellow nasal discharge may have epistaxis sore throat hoarseness with cough enlarged lymph nodes low grade fever increase pulse malaise

59 Management Diagnosed by culture of discharge strict isolation antibiotics-penicillin complete bed rest trach if obstructed airway suctioning

60 PERTUSSIS Whooping Cough

61 Pertussis Affects unvaccinated children of any age Vaccine available for children age 2 months and older (“P” in Dtap) Serious respiratory involvement Death is common due to airway obstruction

62 Symptoms Prodromal symptoms begins with cough and congestion Progresses into a dry, hacking cough that becomes severe, worse at night Cough is short and rapid followed by sudden inspiration and whooping

63 Symptoms Cheeks flush, eyes bulge, tongue protrudes Thick secretions, often vomits Sick for 4-6 weeks www.whoopingcough.net for sound and video

64 Management Hospitalization for infants or children who are dehydrated Bed rest Increase fluids Antibiotics-macrolides Suctioning Humidifier Observe for airway obstruction (restlessness, retractions, cyanosis)

65 SCARLET FEVER

66 Scarlet fever Bacterial infection (strep), often sequela to strep throat Affects mainly schoolage children and adolescents age 5-15 who are susceptible to strep throat Isolation not necessary after 24 hours on antibiotics No vaccine Moderately uncomfortable symptoms

67 Symptoms Prodromal symptoms of abrupt high fever, high pulse, vomit, headache, Malaise, chills, abdominal pain Followed by 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”

68 Symptoms By 4 th or 5 th day white coat sloughs off leaving prominent papillae = “red strawberry tongue” Rash appears of red, pin head sized lesions, rash is intense in folds and joints, flushed cheeks

69 Management Diagnosis made by positive throat culture and ASO titer respiratory isolation x 24 hours 7-10 days of penicillin analgesics for sore throat

70 PRACTICE QUESTIONS!

71 Which of the following statements indicates that a parent understands the treatment for his/her child who has fifth disease? (Select All That Apply) 1. “I will give antibiotic for the full 10 days” 2. “No antibiotic is needed, as this is a viral infection.” 3. “I will apply antibiotic cream to her rash twice a day.” 4. “My child can go back to school when the body rash appears”. 5. “If my child had the vaccine, she wouldn’t have go gotten sick”

72 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 _____ DTaP vaccines by age 24 months.

73 A mother brings her infant to the pediatrician because the baby has had a high fever for 3 days and then developed a rash. The nurse examines the baby to find light pink macules on trunk, neck, face, and extremities. The nurse suspects the baby has: 1. Rubeola 2. Rubella 3. Roseola 4. Scarlet Fever

74 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


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