1. Communicable Diseases
Rubella, Rubeola, Roseola,
Fifth’s Disease, Chicken Pox, Scarlet Fever, Mononucleosis

2. Review terminology r/t communicable diseases:
Incubation period
Prodromal symptoms
Period of communicability
Types of Isolation: contact, respiratory

3. Immunizations can prevent many of these diseases—primary prevention strategy
Careful handwashing to prevent transmission in essential for healthcare practitioners and for families
Infection Control: pp & Box 27-3
Early identification of symptoms so that treatment can be initiated is also paramount to a good outcome.
Prevention

4. If a child is admitted to the hospital with an UNDIAGNOSED EXANTHEMA, strict isolation is instituted until a diagnosis is confirmed.
These are a few communicable diseases that require isolation:
diphtheria
chickenpox
Measles, mumps, rubella
tuberculosis
adenovirus
Haemophilus influenzae type B
influenza
meningitis
Mycoplasma pneumonia, pseudomonas aeroginosa pneumonia
pertussis
RSV
streptococcal pharyngitis, scarlet fever
Clostridium difficile, e.coli, shigella
pneumonia / pneumonic plague /
(AAP, Committee on Infectious Diseases, 2003)
Reportable Communicable Dz list for Cook County

5. Prevent complications
Any immunocompromised children—those receiving steroid or immunosuppressive therapy, are always at risk for viremia, especially from viruses like herpes zoster.
Children with sickle cell anemia may develop aplastic anemia from erythema infectiosum (EI)[Fifth’s Dz]. The human parvovirus (HPV) infects and lyses RBC precursors.
Diphtheria and Scarlet Fever are bacterial and prevention of complications requires compliance with antibiotic therapy.
Prevent complications

6. Prevent complications
High-risk children exposed to chickenpox should receive VZIG (varicella zoster immune globulin).
Acyclovir (Zovirax) may be used to treat varicella infections in high risk children with the disease.
Vitamin A supplementation in high doses has recently been shown to decrease morbidity and mortality rates in measles. Careful instruction to parents on safe storage of Vitamin A is essential.
Prevent complications

7. Alleviate itching that is one of the most common discomforts of rashes
Cool/tepid baths without soap, may use oatmeal
Calamine/Caladryl lotions must be applied sparingly to prevent toxic levels being absorbed. They contain diphenhydramine.
Wear lightweight, loose clothing, keep cool
Keep nails short, wear mittens on young children
Suggest po. Diphenhydramine (Benadryl)
Offer antipyretics (acetominophen or ibuprofen) for fever and general malaise
Lozenges, saline rinses for sore throats
Suggest quiet activities
Provide comfort

8. Support family and child
Provide accurate information re: period of communicability and period of recovery.
Provide support and encouragement.
Review importance of compliance with therapy.
No Salicylate products with all viral diseases because of link to Reye Syndrome
Support family and child

9. Review Table 16-1 Communicable Diseases of Childhood pp
Review Table 16-1 Communicable Diseases of Childhood pp (Hockenberry et al, 9th ed.)
Know association of high fever and febrile seizures with Roseola and importance of careful antipyretic management.
Know common sx of Rubeola (measles) including koplik’s spots, photophobia.
Know period of communicability of Varicella/chickenpox and appropriate counsel to parents re: when child can return to school
Know etiology of Scarlet Fever, common sx, management, and when to return to school
Know risks to fetus if Rubella is contracted in the mother’s first trimester of pregnancy
Know appearance of rash for Fifth Disease (HPV)

10. Which is which??
Fifth Disease
Roseola
Chicken pox
Scarlet Fever

11. Mononucleosis Etiology: Epstein Barr Virus Natural Hx:
Typically self-limiting & uncomplicated
Incubation period: days
Preclinical stage: 3-5 days
Acute illness: 7-20 days
Convalescence: 2-6 weeks
Viral excretion may occur many months after infection
Often asymptomatic and difficult to diagnose
Mononucleosis

12. Mononucleosis (cont’d)
Transmission: through saliva (usually intimate contact, thus the nickname, ‘Kissing Disease’)
Pathophysiology
EBV infects B-lymphocytes lymphoproliferation
Lab results: atypical lymphocytes called Downey cells
 WBC’s especially lymphs and
 liver enzymes
EBV antibody titer 
+ Monospot test
Mononucleosis (cont’d)

13. Mononucleosis (Cont’d)
Signs and Symptoms
General malaise
Sore throat, gelatinous film over palate and uvula, red macules on palate
Tonsillar enlargement, white exudate on tonsils, red pharynx
Fever
Macular rash (trunk)
Abdominal pain
Cervical lymphadenopathy
Splenomegaly
Hepatomegaly
Mononucleosis (Cont’d)

14. Mononucleosis (cont’d)
Population most affected:12-26 yr olds
Nursing concerns
Potential for secondary infection
Potential for injury
School absenteeism
Possible complications:
Aseptic meningitis
Encephalitis
Guillian Barré Syndrome
Splenic rupture
Mononucleosis (cont’d)

15. Primary prevention Secondary prevention Tertiary prevention
General health promotion measures
Secondary prevention
Prompt medical attention for sore throats to r/o strep throat
Screening to r/o secondary bacterial infection
Tertiary prevention
Palliative:
Fever (rest,  calories,  fluids, Acetominophen
Saline gargles
Soft foods
No contact sports
Referral for home-bound teacher, if pt has to stay home for lack of energy and malaise
Can go to school if feels up to it

16. Wash your hands and stop the spread of these communicable diseases!
That should do it!
Wash your hands and stop the spread of these communicable diseases!