1.2k likes | 2.48k Views
Communicable Disease. Communicable Diseases. Of childhood include diseases with high transmission rates Viruses are the leading cause of most pediatric infections. Immunizations. Prevention of any illness is always better than treatment Vaccines are the single best technique for prevention
E N D
Communicable Diseases Of childhood include diseases with high transmission rates • Viruses are the leading cause of most pediatric infections
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
Immunizations • Are either inactivated or activated • Inactivated include Dtap, Hib, Hep • Activated (live) multiplies for days-weeks 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
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
True contraindications and precautions • Moderate-severe illness with or without fever • Immunocompromised • Prior serious reaction (fever 105, seizure, anaphylatic)
Administration • 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 Assessment: • recent exposure • prodromal symptoms • s/s occur early in disease • immunization history • history of having the disease
COMMUNICABLE DISEASES Implementation: • prevent spread • reduce risk of cross contamination • prevent complications • provide comfort Rash Fever Sore throat
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)
Fifth’s 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
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)
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 • 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
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
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 inspiration and whooping** • Cheeks flush, eyes bulge, tongue protrudes • Thick secretions, often vomits • Sick for 4-6 weeks
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
Name That Rash!!!
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)
What has…. • “Koplik spots” on buccal mucosa • Discrete rash on face then spreads downwards on body turns confluent three days later
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
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
What has… • Rose-pink macules first on trunk • spread to neck, face, extremities • not itchy • lasts 1-2 days