1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 14 Communicable and Infectious Disease Risks

2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Describe the natural history of human immunodeficiency virus (HIV) infection and appropriate client education at each stage. 2. Explain the clinical signs of selected communicable diseases. 3. Evaluate the trends in incidence of HIV, STDs, hepatitis, and tuberculosis, and identify groups that are at greatest risk.

3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 4. Analyze behaviors that place people at risk of contracting selected communicable diseases. 5. Evaluate nursing activities to prevent and control selected communicable diseases. 6. Explain the various roles of nurses in providing care for those with selected communicable diseases.

4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Human Immunodeficiency Virus Infection Natural History of HIV Transmission Epidemiology of HIV/AIDS HIV Surveillance HIV Testing Perinatal and Pediatric HIV Infection AIDS in the Community Resources

5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Natural History of HIV  Three stages:  Primary infection (within about 1 month of contracting virus)  Incubation period (when body shows no symptoms) Use of highly active antiretroviral therapy (HAART) has greatly increased survival time of persons with HIV/AIDS  Symptomatic disease (AIDS) CD4 T-lymphocyte count less than 200/ml with documented HIV infection AIDS-related opportunistic infections

6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Transmission  Transmitted through exposure to blood, semen, transplanted organs, vaginal secretions, and breast milk  Those who have had blood, sexual, or needle- sharing exposure with an HIV-infected person are at risk for contracting the virus.  IS NOT transmitted through casual contact (touching or hugging someone), or through mosquitoes or other insects

7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Epidemiology of HIV/AIDS  First cases of AIDS identified in 1981  Worldwide 28 million people live with HIV infection  Sub-Saharan Africa accounts for two thirds of all HIV infections  Epidemic also growing in Central Asia and Eastern Europe  Treatment for HIV infection has been given higher priority.  Prevalence of AIDS has increased.

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIV/AIDS Cases by Exposure, 2008

9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIV Surveillance  2008: Confidential reporting of HIV-positive status by name required in all 50 states and the District of Columbia

10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIV Testing  HIV antibody test  Indicates the presence of the antibody to HIV  Enzyme-linked immunosorbent assay (EIA) Screens blood and other donor products  Does not reveal whether individual has symptomatic AIDS, nor does it isolate the virus  Western blot  Confirmatory test minimizes false-positive results  Routine testing and voluntary screening

11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Perinatal and Pediatric HIV Infection  Accounts for nearly all HIV infection in children and can occur during pregnancy, labor and delivery, or breastfeeding  HAART in pregnant women  Recommended that HIV testing be routine part of prenatal care; all pregnant women should be tested for HIV  Despite having an HIV-infected mother, many children do not acquire HIV/AIDS.  However one or both parents may die.

12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. AIDS in the Community  Americans with Disabilities Act of 1990  Mental health issues  HIV-infected children attending school

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Resources  Voluntary and faith-based service organizations  Toll-free numbers and websites

14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Gonorrhea Syphilis Chlamydia Herpes Simplex Virus 2 (Genital Herpes) Human Papillomavirus Infection

15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Gonorrhea  Bacterium that infects the mucous membranes of the genitourinary tract, rectum, and pharynx  Transmitted through genital-genital contact, oral-genital contact, and anal-genital contact  Uncomplicated or complicated  Southeast United States has consistently high rates  Number of antibiotic-resistant cases in United States has risen

16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Syphilis  Infects moist mucous or cutaneous membranes  Spread through direct contact, usually by sexual contact or from mother to fetus  Transmission via blood transfusion may occur if the donor is in the early stages of disease  Highest rates are among MSM; recently, number of infected women has increased  Clinical signs divided into primary, secondary, and tertiary infections  Congenital syphilis

17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chlamydia  Infects the genitourinary tract and rectum of adults and causes conjunctivitis and pneumonia in neonates  Transmission occurs when mucopurulent discharge from infected sites, such as the cervix or urethra, comes into contact with the mucous membranes of a non-infected person.  Most common reportable infectious disease

18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Herpes Simplex Virus 2 (Genital Herpes)  No cure  Transmitted through direct exposure and infects the genitalia and surrounding skin  Occurs in 20% of American adolescents and adults  Linked with development of cervical cancer

19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Human Papillomavirus (HPV) Infection  Results in genital warts  Can infect the mouth, genitals, and anus  Transmission of HPV occurs through direct contact with warts that result from HPV.  Specific types cause cervical cancer.  Gardasil vaccine

20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hepatitis Hepatitis A Virus Hepatitis B Virus Hepatitis C Virus

21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hepatitis A Virus (HAV)  Most commonly transmitted through the fecal- oral route  Sources may be water, food, feces, or sexual contact  Found worldwide  Vaccine available since 1995  Incidence has declined 92%  Makes HAV completely preventable  High-risk groups

22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hepatitis B Virus (HBV)  Spread through blood and body fluids  Remains alive outside of the body for at least 1 week  Vaccine available  High-risk groups  Acute or chronic infections  OSHA regulations

23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hepatitis C Virus (HCV)  Most common chronic bloodborne infection in United States  Transmitted when blood or body fluids of an infected person enter an uninfected person  High-risk groups  Spread rapidly during 1980s  Chronic liver disease from HCV is twelfth leading cause of death in adults in United States and most common reason for liver transplant

24 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Tuberculosis (TB)  Transmission usually occurs through exposure to the tubercle bacilli in airborne droplets from persons with pulmonary tuberculosis who talk, cough, or sneeze.  WHO estimated one third of world is infected with TB (WHO, 2009)  Asia accounts for 55% of cases  Africa accounts for 31% of cases  In United States, nearly half of new cares occur in NY, FL, TX, and CA

25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. TB: Diagnosis and Treatment  Tuberculin skin test (TST)  Previously called purified protein derivative (PPD) test  Used for initial screening  Followed by chest x-ray for persons with positive skin reaction and pulmonary symptoms  Treated promptly with combination of multiple antimicrobial drugs  Treatment failure may be due to lack of adherence, which can result in drug resistance

26 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nurse’s Role  Primary prevention  Education of how to avoid infection  Secondary prevention  Testing and counseling for HIV  Post-test counseling  Partner notification and contact tracing  Tertiary prevention  Observed therapy  Standard precautions