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COMMUNICABLE DISEASE HEAD START Joyce M. Smith M.D., MPH.

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Presentation on theme: "COMMUNICABLE DISEASE HEAD START Joyce M. Smith M.D., MPH."— Presentation transcript:

1 COMMUNICABLE DISEASE HEAD START Joyce M. Smith M.D., MPH

2 CHILD CARE / EARLY EDUCATION SETTING Group Setting ◦ Increased risk of infectious disease spread ◦ Among children  Younger than 2 years  Rates of Infection tend to Increase for first 6 months  Rates decrease after six months of attendance ◦ Children are 2 to 18 times more likely to catch an infectious disease than non-group

3 CHILD CARE / EARLY EDUCATION SETTING Adult Care Givers ◦ Increased risk of acquiring and spreading infection in the first year Spread depends on environmental and host variables ◦ Season, crowding, hygiene practices ◦ Immune status of host ◦ Virulence of germ or pathogen

4 INCREASE TRANSMISSION (Short List) Otitis Media – Ear infections Pneumonia Diarrhea Hepatitis A Streptococcal Infection Rotavirus Chicken pox (Varicella)

5 CONDITIONS FOR TRANSMISSION ◦ Pathogen (Germ) – must be present ◦ Adequate quantity present ◦ Susceptible Host ◦ Correct portal of entry

6 MODES OF TRANSMISSION Airborne Droplet Direct Contact (Fecal Oral) Fomites (Common Vehicle) Bloodborne Vectorborne

7 RESPIRATORY CONDITIONS COMMON COLD Pathogen ◦ Virus (many strains) Symptoms: ◦ Runny Nose, Congestion, Headache, Cough, Muscle aches ◦ Little or no fever Mode of Transmission ◦ Droplets ◦ Respiratory

8 RESPIRATORY CONDITIONS COMMON COLD Incubation Period ◦ 1 to 3 days Period of Contagiousness ◦ 1 day before up to 5 days after start of symptoms Management ◦ Supportive Prevention of Spread ◦ Cover Cough, Hand Hygiene Only excluded if fever is present

9 RESPIRATORY CONDITIONS PHARYNGITIS VIRAL Pathogen – Viruses (Multiple Strains) Symptoms – ◦ Gradual onset of sore throat, runny nose, cough + diarrhea, + fever Mode of Transmission: ◦ Respiratory, droplets, close contacts Management – ◦ Supportive, pain and fever medication as indicated

10 RESPIRATORY CONDITIONS STREPTOCOCCAL PHARYNGITIS Pathogen – ◦ Bacteria Streptococcus “Strep Throat” GABHS Symptoms – ◦ Rapid onset, painful swallowing, fever, headache, muscle aches, enlarged tonsils, enlarged lymph nodes ◦ Mode of Transmission  Respiratory, Close Contacts

11 RESPIRATORY CONDITIONS STREPTOCOCCAL PHARYNGITIS Incubation Period ◦ 1 – 3 days ◦ May develop scarlet fever Period of Contagiousness ◦ Treated 24 to 48 hours ◦ Untreated – 10 days  May lead to Rheumatic Fever Management ◦ Antibiotics within 9 days

12 PHARYNGITIS Nonspecific Pharyngitis, can be produced by several pathogens. Physical exam + Lab for final diagnosis Nelson’s Textbook of Pediatrics, 19 th edition

13 PHARYNGITIS More erythematous (red) with petechiae on roof of mouth, suggestive of strep infection

14 PHARYNGITIS White exudate on tonsils suggestive of Strep or Mono infection

15 RESPIRATORY CONDITIONS CROUP Upper Respiratory Infection with partial obstruction, causing noisy breathing (stridor) and respiratory distress Causes Bark-like cough Mostly affects children 3 months to 5 years (Video of Croup)

16 RESPIRATORY CONDITIONS CROUP Pathogen ◦ Usually a virus Symptoms ◦ Starts as mild cold-like illness for 1-3 days ◦ then strider and bark-like cough develop ◦ Fever can be low grade or high – 104 ◦ Can become hypoxic and need hospitalization Mode of Transmission - Respiratory

17 RESPIRATORY CONDITIONS CROUP Management ◦ Usually can be managed at home ◦ Keep calm, respiratory distress increases with distress and crying ◦ To Emergency Room if respiratory distress worsens ◦ Medication can be used for severe cases

18 RESPIRATORY CONDITIONS EAR INFECTION (OTITIS MEDIA) Middle Ear Infection 80% of children have at least one episode of Otitis Media Peak incidence in the first 2 years of life Most cases are self-limited Pathogen – Virus or Bacteria Symptoms ◦ Fever, ear pain,

19 RESPIRATORY CONDITIONS EAR INFECTION (OTITIS MEDIA) Risk factors ◦ Age – highest rates in 6 to 20 month old  Anatomy – smaller facial structures allow local spread ◦ Smoke Exposure  Preventable risk factor ◦ Pacifier use  Small increase Risk ◦ Breast Milk  Protective affect

20 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) Viral Bacterial Allergic Other conditions

21 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) Viral and Bacterial ◦ Highly contagious ◦ Spread by touching contaminated objects (fomites) ◦ Poor hand hygiene Allergic – Not contagious ◦ Usually bilateral

22 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) Symptoms ◦ Redness or Pink eyes with white or yellow discharge ◦ May have ild eye pain Mode of Transmission ◦ Direct Contact Incubation Period – 1 to 3 days Period of Contagiousness – until redness resolves or determined to be non- contagious

23 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) VIRAL – Usually watery discharge Medicine.net.com

24 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) BACTERIAL HAS THICK GREENISH YELLOW DISCHARGE

25 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) BACTERIAL ASSOCIATED WITH YELLOW CRUSTED DISCHARGE

26 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) MANAGEMENT ◦ Hand Hygiene- Prevent spread to other eye, prevent spread to other people  Prevent progression of viral or allergic to bacterial ◦ Bacterial – Antibiotic Eye Drops ◦ Viral – Self limited ◦ Allergic – Topical Antihistamines

27 COMMON SKIN PRESENTATIONS **Measles – Viral, preventable through vaccination  Pathogen  Symptoms  Mode of Transmission  Incubation Period  Period of Contagiousness  Management

28 ***MEASLES Pathogen – Measles Virus Symptoms ◦ 2 – 4 days of prodrome  Fever, , Harsh Cough, Watery Reds Eyes,  Then blotchy red rash starts 14 to 21 days post exposure on face and spreads to the body  Rash lasts 4 to 7 days Mode of Transmission ◦ Highly Contagious ◦ Direct Contact with oral and nasal secretions ◦ Contaminated clothing (*** Reportable; One case reported in Illinois in 2013)

29 MEASLES Incubation Period ◦ 8 to 12 days – range 7 to 18 days Period of Contagiousness ◦ Slightly before prodrome until 4 days after rash develops Complications may include ◦ Pneumonia ◦ Meningitis ◦ Otitis Media ◦ Death

30 MEASLES Hurwitz Clinical Pediatric Dermatology Third Edition Intensely erythematous pathches of the face with spreading inferiorly onto the trunk

31 RUBELLA – GERMAN MEASLES Pathogen – German Measles Virus Symptoms – 3-Day Measles ◦ Mild disease, mild fever, swollen glands ◦ Rash last 2 to 3 days Mode of Transmission ◦ Contact with respiratory droplets Incubation Period ◦ 14 to 21 days Period of Contagiousness Management - Immunization

32 RUBELLA GERMAN MEASLES Hurwitz Clinical Pediatric Dermatology Third Edition Nonspecific “rose pink” macules and papules on the trunk of an adolescent male

33 ***VARICELLA (CHICKEN POX) Pathogen - VZV Varicella-Zoster Virus Incubation Period ◦ 10 to 21 days Symptoms ◦ Sudden onset, mild fever itchy rash starts as maculopapular and progresses to vesicles, then crust, more develop – different stages of healing, ◦ Ave about 300 lesions. Much worse in older children and adults

34 ***VARICELLA (CHICKEN POX) Mode of Transmission ◦ Direct Contact with respiratory droplets and contaminated items, touching skin vesicles Period of Contagiousness ◦ 24 to 48 hours before the rash until lesions are crusted Management / Complications ◦ ***Reportable to the city ◦ Notification of parents, VZIG within 96 hours of exposure ◦ Immunizations

35 ***VARICELLA (CHICKEN POX) UNIMMUNIZED CHILD

36 ***VARICELLA (CHICKEN POX) BREAK THROUGH LESIONS OF IMMUNIZED CHILD

37 FIFTH DISEASE (Erythema Infectiosum) Pathogen – Parvovirus B19 Incubation Period – 4 to 28 days Symptoms – Usually benign, mild fever slapped cheek rash, progress to lacy appearance Mode of Transmission – Respiratory nasal droppings Period of Contagiousness – right before rash

38 FIFTH DISEASE (Erythema Infectiosum) Erythema of the cheeks giving a “slapped cheeks” appearance

39 FIFTH DISEASE (Erythema Infectiosum) Reticulate erythema lacy rash on upper arm

40 HAND-FOOT AND MOUTH DISEASE Pathogen –Coxsackie Virus A 16 Incubation Period Symptoms – Mild Illness with low grade fever, on ulcers on Mouth and blisters Hands and Feet Mode of Transmission Period of Contagiousness – Before lesions appear and for several weeks after

41 HAND-FOOT AND MOUTH DISEASE Deep-seated vesicles with erythema involving the palmar surface of the hand

42 HAND-FOOT AND MOUTH DISEASE A painful ulcer on the lateral aspect of the tongue

43 HAND-FOOT AND MOUTH DISEASE Red to purple vesicles involving the knee

44 HAND-FOOT AND MOUTH DISEASE

45 WARTS (VERRUCA) Pathogen – HPV ◦ Human Papilloma Virus (Multiple strains more than 200) ◦ Usually benign in children and adolescents ◦ Incidence is highest in children and adolescents Incubation Period – ◦ Develop lesions one month after inoculation Symptoms – ◦ Slow developing growth, sometimes painful ◦ Usually less than 3 in mm in size

46 WARTS (VERRUCA) Mode of Transmission – ◦ Direct contact, autoinoculation and fomites Period of Contagiousness, no limits, can be covered to avoid direct contact Management / Complications ◦ 65% disappear within 2 years ◦ Liquid Nitorgen ◦ Salicyclic Acid – Compound W ◦ podophyllin

47 WARTS (VERRUCA) Multiple Forms ◦ Flat ◦ Filiform ◦ Plantar ◦ Common ◦ Periungual

48 COMMON WARTS (VERRUCA) A dome-shaped lesion on the nose and filliform wart down below

49 COMMON WART (VERRUCA) Common Wart on the Tongue

50 PLANTAR WARTS (VERRUCA)

51 SUBUNGAL WARTS Verrucous papules under the thumb and index finger with extension under the nail plate

52 MOLLUSCUM CONTAGIOSUM Pathogen – Poxvirus Incubation Period ◦ Greater than 2 weeks Symptoms ◦ Occurs mainly on children and immune compromised adults. Discreet pearly to flesh colored dome shape papules with umbilicated center ◦ Anywhere on the body. Ave last 6 to 9 months ◦ May persist for years

53 MOLLUSCUM CONTAGIOSUM Mode of Transmission ◦ Direct Contact ◦ Fomites ◦ Autoinoculation Period of Contagiousness – May be present for years Management ◦ Self limited ◦ Curettage (scraping) is the treatment of choice

54 MOLLUSCUM CONTAGIOSUM Solid dome shaped pearly papule

55 MOLLUSCUM CONTAGIOSUM

56 FUNGAL DISEASE OF SKIN TINEA Tinea ◦ Capitus (Ring Worm of the Scalp) ◦ Corporis (Ring Worm of the body) ◦ Pedis (Athletes Foot) ◦ Versicolor Intertrigo – In skin folds

57 FUNGAL DISEASE OF SKIN TINEA CAPITUS Pathogen – Fungus – Dermatophytes affect skin Incubation Period Symptoms ◦ Hair loss, “Black dot” hair breaks off near the scalp; Diffuse flakiness with little or no hair loss; Sever inflammatorty reactions produces kerions Mode of Transmission ◦ Direct contact with fomites  Combs, brushes, chairs, hats Period of Contagiousness – ◦ Ongoing without treatment Management ◦ Oral antifungal medication for 6 to 8 weeks

58 FUNGAL DISEASE OF SKIN TINEA CAPITUS BLACK-DOT RING WORM

59 FUNGAL DISEASE OF SKIN TINEA CAPITUS - KERION

60 FUNGAL DISEASE OF SKIN TINEA CORPORIS (Body) Pathogen – Fungal Dermatophyte Incubation Period Symptoms ◦ Round reddish, scaly areas that progress to centrally clean can be millimeters or centimeters in size

61 FUNGAL DISEASE OF SKIN TINEA CORPORIS (Body) Mode of Transmission ◦ Direct Contact ◦ Infected Pet Period of Contagiousness ◦ As long as lesions are present Management ◦ Topical antifungal medication – OTC ◦ Small lesions can be covered to decrease spreading

62 FUNGAL DISEASE OF SKIN TINEA VERSICOLOR Hypopigmented minimally scaly macules and patches on trunk

63 FUNGAL DISEASE OF SKIN TINEA VERSICOLOR Tinea Versicolor in dark skinned person

64 BACTERIAL SKIN DISORDERS Scarlet Fever ◦ Abcesses ◦ Impetigo

65 BACTERIAL SKIN DISORDERS SCARLET FEVER Scarlet fever in a dark-skinned person. The rash resembles “gooseflesh.” Note the beginning of desquamation

66 BACTERIAL SKIN DISORDERS Post-scarlet fever desquamation. Extensive peeling of the hands following treatment

67 BACTERIAL SKIN DISORDERS ABCESS (CARBUNCLE) Large, tender eythematous swelling on lateral trunk of teenager.. Note small adjacent furnacle

68 BACTERIAL SKIN DISORDERS IMPETIGO (BULLOUS) Multiple tender eythematous patches with a peripheral collarette representing the remnants of the blister roof

69 BACTERIAL SKIN DISORDERS IMPETIGO These multiple lesion have spread as a result of autoinoculation

70 INFESTATIONS LICE Head Lice Scabies

71 INFESTATIONS HEAD LICE Pathogen- Insect (Pediculosis) Incubation Period ◦ Eggs hatch in seven to ten days Symptoms ◦ Scratching of head ◦ Identification of nits (eggs) attached to hair and lice present Mode of Transmission ◦ Direct contact with an infested person, clothing or article Period of Contagiousness ◦ As long as eggs are not treated Management ◦ Application of 1% Permethrin Creme leave on 10 mintues then wash out ◦ Consider second treatment 1 – 2 weeks later

72 INFESTATIONS HEAD LICE Nits and Lice Visible on hair

73 INFESTATIONS SCABIES Pathogen ◦ Body Lice – Arthropods ◦ Mite ◦ Obligate human parasite Incubation Period ◦ Two to six weeks – first time ◦ One to four days – future infestations Symptoms ◦ Itching, scratching, papulosquamous lesions

74 INFESTATIONS SCABIES Mode of Transmission ◦ Direct contact with infested individuals ◦ Possibly fomites Period of Contagiousness ◦ Until 24 hours after treatment Management ◦ Application of Permethrin ◦ Wash off in 8 hours

75 INFESTATIONS SCABIES

76 INFESTATIONS SCABIES

77 INFESTATIONS SCABIES Scabies lesions with burrows of egg deposits under the skin

78 INFESTATIONS SCABIES

79 COMMUNICABLE DISEASES  QUESTIONS?

80 References Hurwitz: Clinical Pediatric Dermatology, third edition Nelsons Textbook of Pediatrics, 19th edition Communicable Disease Guide, Illinois Department of Public Health 2002 Web M.D.


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