Communicable Disease

1. Communicable Disease

2. Communicable Diseases Of childhood include diseases with high transmission rates • Viruses are the leading cause of most pediatric infections

3. Immunizations • Prevention of any illness is always better than treatment • Vaccines are the single best technique for prevention • Immunization Schedule…. • By 24 Months children should have: • 4 Dtap, Hib, PCV • 3 Hep B, IVP • 1 MMR, varicella

4. Immunizations • Are either inactivated or activated • Inactivated include Dtap, Hib, Hep • Activated (live) multiplies for days-weeks in body MMR, Varicella

5. 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)

6. Reaction to Vaccines • local tenderness • erythema • swelling at site • low grade fever (possibly high with activated) • behavior changes

7. Barriers to Immunization • Complexity of the health care system • Expense • Parental misconceptions • Inaccurate recordkeeping • Reluctance of health care workers to give more than two vaccines at a time • Lack of public awareness

8. True contraindications and precautions • Moderate-severe illness with or without fever • Immunocompromised • Prior serious reaction (fever 105, seizure, anaphylatic)

9. Administration • Proper storage • Reconstitution • Expiration date • Consent • Documentation (immunization record)

10. Atraumatic care • Select needle of adequate length • Select proper site • VL infants • Deltoid > 18 months • Minimize pain • EMLA cream • Distraction

11. COMMUNICABLE DISEASES Assessment: • recent exposure • prodromal symptoms • s/s occur early in disease • immunization history • history of having the disease

12. COMMUNICABLE DISEASES Implementation: • prevent spread • reduce risk of cross contamination • prevent complications • provide comfort Rash Fever Sore throat

13. Viral Infections

14. 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

15. 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

16. 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

17. 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)

18. Fifth’s Disease • Parvovirus (HPV B19) • No vaccine available • Transmitted by probable respiratory secretions • Easily Communicable up to 14 days after infection

19. Symptoms • Classic rash of erythema on face (cheeks), “slapped face appearance” • High fever, lethargy, n/v, abd. Pain, cervical lympadnopathy

20. Followed with maculopapular red spots appear in 1 week, symmetrically on upper and lower extremities has a lace-like appearance • rash subsides, but reappears if skin is irritated (sun, heat, cold)

21. 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

22. 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

23. 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

24. 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

25. Symptoms • Fever, malaise, cough, coryza, conjunctivitis for 24 hours • then “Koplik spots” (small, irregular, red spots with minute bluish-white center) • first seen on buccal mucosa => rash on face that spreads downward • Rash is discrete, then turns confluent on the third day • Other symptoms persist

26. 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

27. Mumps • Viral infection • Vaccine available 2nd “M” in MMR • Transmitted by direct contact of saliva and respiratory droplet • Communicable immediately before swelling begins

28. Symptoms • Fever, HA, M, Anorexia, x 24 hours, earache aggravated by chewing • On 3rd day: parotitis (enlarged parotid gland), unilateral or bilateral, pain, tenderness

29. 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

30. 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

31. 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

32. Diagnosis and Management • Diagnosis by symptoms, serology available 1 month after infection • Treatment • Antipyretics • Comfort measures **Pregnant people must avoid infected child=fetal death

33. Bacterial Infections

34. Diphteria • Bacterial infection • Vaccine available “D” in Dtap • Transmitted by direct contact with respiratory secretions,droplet, contaminated objects Communicable 2-4 weeks=highly contagious

35. 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

36. Diagnosis and Management • Diagnosed by culture of discharge • strict isolation • abx (PCN) • complete BR • trach if obstructed airway • suctioning

37. Pertussis(whooping cough) • Bacterial infection • Vaccine available “P” in Dtap • Transmitted by direct contact, droplet • Communicable for up to 4 weeks

38. Symptoms • Begins with URI symptoms: • dry, hacking cough that becomes severe, worse at night **short, rapid coughs followed by sudden inspiration and whooping** • Cheeks flush, eyes bulge, tongue protrudes • Thick secretions, often vomits • Sick for 4-6 weeks

39. 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)

40. 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

41. 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”

42. 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

43. Diagnosis and Management • Diagnosis + TC, ASO titer • Management: • respiratory isolation x 24 hours • full course of PCN/EES • analgesics for sore throat

44. Lets Play a Game….

45. Name That Rash!!!

46. What has…. • Erythema on cheeks “slapped face appearance” • Followed with maculopapular erythema rash symmetrically on upper and lower extremities has a lace-like appearance • Rash may reappears if skin is irritated (sun, heat, cold)

47. What has…. • “Koplik spots” on buccal mucosa • Discrete rash on face then spreads downwards on body turns confluent three days later

48. What has….. • 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 • Rash starts on trunk and progresses to body including genitalia, mucous membranes

49. What has…. • Small vesicles initially filled with serous fluid then become pustular • Vesicles (bullae) rupture rapidly • Honey-colored fluid from lesions becomes crusted mildly pruritic • Lesions appear around mouth and nose

50. What has… • Rose-pink macules first on trunk • spread to neck, face, extremities • not itchy • lasts 1-2 days