1. INFECTIOUS AND COMMUNICABLE DISEASES

2. PYRAMID POINTS
Clinical manifestations of the various infectious and communicable diseases
Infectious periods of the various infectious and communicable diseases
Methods of transmission of the various infectious and communicable diseases
Teaching related to measures to prevent transmission of infectious and communicable diseases
Immunization schedules
Contraindications to immunizations

3. RUBEOLA (MEASLES) AGENT Virus INCUBATION PERIOD 10 to 20 days
COMMUNICABLE PERIOD
From 4 days before to 5 days after the rash appears; mainly during prodromal (catarrhal) stage

4. RUBEOLA (MEASLES) SOURCE
Respiratory tract secretions, blood, and urine of infected person
TRANSMISSION
Airborne or direct contact with infectious droplets

5. RUBEOLA (MEASLES) ASSESSMENT Fever Malaise Coryza and cough
Rash appears as red, discrete maculopapules that blanch easily with pressure and gradually turn a brownish color (lasts 6 to 7 days); rash begins behind the ears and spreads downward to the feet
Koplik’s spots: small, red spots with a bluish-white center and a red base located on the mucosa that last 3 days

6. RUBEOLA (MEASLES)
From Seidel HM et al (1995): Mosby’s guide to physical examination, (3rd ed.), St. Louis: Mosby.

7. RUBEOLA (MEASLES)
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

8. KOPLIK SPOTS
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

9. RUBEOLA (MEASLES) IMPLEMENTATION
Respiratory precautions if hospitalized
Restrict to quiet activities and bed rest
Use a cool mist vaporizer for cough and coryza
Dim lights if photophobia is present
Administer antipyretics for fever

10. ROSEOLA (EXANTHEMA SUBITUM)
AGENT
Human herpesvirus type 6 (HHV-6)
INCUBATION PERIOD
5 to 15 days
COMMUNICABLE PERIOD
Unknown but thought to extend from the febrile stage to the time the rash first appears
SOURCE
Unknown
TRANSMISSION

11. ROSEOLA (EXANTHEMA SUBITUM)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.

12. ROSEOLA (EXANTHEMA SUBITUM)
ASSESSMENT
Fever for 3 to 5 days followed by a rash (rose-pink macules that blanch with pressure)
The rash appears 2 to 3 days after the onset of fever and lasts 1 to 2 days
IMPLEMENTATION
Supportive

13. RUBELLA (GERMAN MEASLES)
AGENT
Rubella virus
INCUBATION PERIOD
14 to 21 days
COMMUNICABLE PERIOD
7 days before to approximately 5 days after the rash appears
SOURCE
Nasopharyngeal secretions; virus is also present in blood, stool, and urine

14. RUBELLA (GERMAN MEASLES)
TRANSMISSION
Airborne or direct contact with infectious droplets
Indirectly via articles freshly contaminated with nasopharyngeal secretions, feces, or urine
Transplacental

15. RUBELLA (GERMAN MEASLES)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.

16. RUBELLA (GERMAN MEASLES) RASH
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

17. RUBELLA (GERMAN MEASLES)
ASSESSMENT
Low-grade fever
Malaise
Pinkish-red maculopapular rash that begins on the face and spreads to the entire body
Petechiae may occur on the soft palate
IMPLEMENTATION
Supportive treatment
Isolate the infected child from pregnant women

18. MUMPS AGENT Paramyxovirus INCUBATION PERIOD 14 to 21 days
COMMUNICABLE PERIOD
Immediately before and after the swelling begins
SOURCE
Saliva of infected person and possibly urine

19. MUMPS TRANSMISSION Direct contact with infected person
Droplet spread from infected person
ASSESSMENT
Fever
Headache and malaise
Anorexia
Earache aggravated by chewing, followed by parotid glandular swelling

20. MUMPS IMPLEMENTATION Respiratory precautions
Bed rest until the parotid glandular swelling subsides
Avoid foods that require chewing
Apply hot or cold compresses as prescribed to the neck
To relieve orchitis, apply warmth and local support with tight-fitting underpants

21. CHICKENPOX (VARICELLA)
AGENT
Varicella zoster virus (VZV)
INCUBATION PERIOD
13 to 17 days
COMMUNICABLE PERIOD
1 day before eruption of lesions (prodromal) to 6 days after the first crop of vesicles, when crusts have formed

22. CHICKENPOX (VARICELLA)
SOURCE
Respiratory tract secretions of infected person; skin lesions
TRANSMISSION
Direct contact, droplet (airborne) spread, and contaminated objects

23. CHICKENPOX (VARICELLA)
ASSESSMENT
Slight fever, malaise, and anorexia followed by a macular rash that first appears on the trunk and scalp and moves to the extremities
Lesions become pustules, begin to dry, and develop a crust
Lesions may appear on the mucous membranes of the mouth, the genital area, and the rectal area

24. STAGES OF LESIONS IN CHICKENPOX
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

25. CHICKENPOX (VARICELLA) RASH
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

26. CHICKENPOX (VARICELLA)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.

27. CHICKENPOX (VARICELLA)
IMPLEMENTATION
In the hospital setting, strict isolation
In the home setting, isolate the infected child until the vesicles have dried
Isolate high-risk children from the infected child

28. PERTUSSIS (WHOOPING COUGH)
AGENT
Bordetella pertussis
INCUBATION PERIOD
5 to 21 days (usually 10 days)
COMMUNICABLE PERIOD
Greatest during the catarrhal stage
SOURCE
Discharge from the respiratory tract of the infected person

29. PERTUSSIS (WHOOPING COUGH)
TRANSMISSION
Direct contact or droplet spread from infected person; indirect contact with freshly contaminated articles
ASSESSMENT
Symptoms of respiratory infection followed by increased severity of cough

30. PERTUSSIS (WHOOPING COUGH)
IMPLEMENTATION
Isolation during the catarrhal stage; if hospitalized, institute respiratory precautions
Administer antimicrobial therapy as prescribed
Administer pertussis-immune globulin as prescribed

31. PERTUSSIS (WHOOPING COUGH)
IMPLEMENTATION
Reduce environmental factors that promote paroxysms of cough such as dust, smoke, and sudden changes in temperature
Encourage fluid intake
Provide high humidity with the use of a humidifier or tent

32. DIPHTHERIA AGENT Corynebacterium diphtheriae INCUBATION PERIOD
2 to 5 days
COMMUNICABLE PERIOD
Variable; until virulent bacilli are no longer present (three negative cultures), usually 2 weeks but as long as 4 weeks

33. DIPHTHERIA
SOURCE
Discharge from the mucous membrane of the nose and nasopharynx, skin, and other lesions of the infected person
TRANSMISSION
Direct contact with infected person, carrier, or contaminated articles

34. DIPHTHERIA ASSESSMENT Low-grade fever, malaise, sore throat
Foul-smelling, mucopurulent nasal discharge
Gray membrane on the tonsils and pharynx
Lymphadenitis (neck edema)

35. DIPHTHERIA IMPLEMENTATION Strict isolation of the hospitalized child
Administer antitoxin as prescribed (preceded by a skin or conjunctival test to rule out sensitivity to horse serum)
Bed rest
Administer antibiotics as prescribed

36. POLIOMYELITIS AGENT Enteroviruses INCUBATION PERIOD 7 to 14 days
COMMUNICABLE PERIOD
Not exactly known; the virus is present in the throat and feces shortly after infection and persists for approximately 1 week in the throat and 4 to 6 weeks in the feces

37. POLIOMYELITIS
SOURCE
Oropharyngeal secretions and feces of the infected person
TRANSMISSION
Direct contact with infected person; fecal-oral and oropharyngeal routes

38. POLIOMYELITIS ASSESSMENT
Fever, malaise, anorexia, nausea, headache, sore throat
Abdominal pain followed by soreness and stiffness of the trunk, neck, and limbs that progresses to flaccid paralysis

39. POLIOMYELITIS IMPLEMENTATION Enteric precautions Supportive treatment
Bed rest
Monitor for respiratory paralysis
Physical therapy

40. SCARLET FEVER AGENT Group A, beta-hemolytic streptococci
INCUBATION PERIOD
1 to 7 days
COMMUNICABLE PERIOD
During the incubation period and clinical illness, approximately 10 days; during the first 2 weeks of the carrier stage, although may persist for months

41. SCARLET FEVER
SOURCE
Nasopharyngeal secretions of infected person and carriers
TRANSMISSION
Direct contact with infected person or droplet spread; indirectly by contact with contaminated articles, ingestion of contaminated milk, or other foods

42. SCARLET FEVER ASSESSMENT
Abrupt high fever, vomiting, headache, malaise, abdominal pain
A red, fine papular rash in the axilla, groin, and neck that spreads to cover the entire body
The rash blanches with pressure except in areas of deep creases and folds of the joints (Pastia’s sign)

43. SCARLET FEVER RASH
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

44. SCARLET FEVER ASSESSMENT
The tongue is coated and papillae become red and swollen (white strawberry tongue); by the fourth to fifth day the white coat sloughs off leaving prominent papillae (red strawberry tongue)
Tonsils are edematous and covered with a gray-white exudate
Pharynx is edematous and beefy-red in color

45. WHITE STRAWBERRY TONGUE AND RED STRAWBERRY TONGUE
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.

46. SCARLET FEVER IMPLEMENTATION
Respiratory precautions until 24 hours after the initiation of treatment
Supportive therapy
Bed rest
Encourage fluid intake
Administer antibiotics as prescribed

47. ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
AGENT
Human parvovirus B19 (HPV)
INCUBATION PERIOD
4 to 14 days, may be as long as 20 days
COMMUNICABLE PERIOD
Uncertain but before the onset of symptoms in most children

48. ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
SOURCE
Infected person
TRANSMISSION
Unknown; possibly respiratory secretions and blood

49. ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
ASSESSMENT
Fever
Myalgia
Lethargy
Nausea
Vomiting
Abdominal pain

50. ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
STAGES OF THE RASH
Erythema of the face (slapped face appearance) chiefly on the cheeks; disappears by 1 to 4 days
Approximately 1 day after the rash appears on the face, maculopapular red spots appear, symmetrically distributed in the extremities; rash progresses from proximal to distal surfaces and may last a week or more
Rash subsides but may reappear if the skin becomes irritated or traumatized by such factors as the sun, heat, cold, or friction

51. ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.

52. ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
IMPLEMENTATION
Respiratory isolation in the hospitalized child
Pregnant women should not be in contact with or care for the infected person
Supportive
Administer antipyretics, analgesics, and antiinflammatory medications as prescribed

53. INFECTIOUS MONONUCLEOSIS
AGENT
Epstein Barr (EB) virus
INCUBATION PERIOD
4 to 6 weeks
COMMUNICABLE PERIOD
Unknown, the virus is shed before the onset of the disease until 6 months or longer after recovery

54. INFECTIOUS MONONUCLEOSIS
SOURCE
Oral secretions
TRANSMISSION
Direct intimate contact, infected blood

55. INFECTIOUS MONONUCLEOSIS
ASSESSMENT
Fever, sore throat, malaise, headache, fatigue, nausea, abdominal pain
Lymphadenopathy and hepatosplenomegaly

56. INFECTIOUS MONONUCLEOSIS
IMPLEMENTATION
Supportive
Monitor for signs of splenic rupture, which includes abdominal pain, left upper quadrant pain, or left shoulder pain

57. ROCKY MOUNTAIN SPOTTED FEVER
AGENT
Rickettsia rickettsii
INCUBATION PERIOD
2 to 14 days
SOURCE
Tick; mammal source: wild rodents, dogs
TRANSMISSION
Bite of infected tick

58. HARD TICK: SOURCE OF ROCKY MOUNTAIN SPOTTED FEVER
From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice, Philadelphia: W.B. Saunders. Courtesy of the Centers for Disease Control and Prevention.

59. ROCKY MOUNTAIN SPOTTED FEVER
ASSESSMENT
Fever, malaise, anorexia, vomiting, headache, myalgia
Maculopapular or petechial rash primarily on the extremities (ankles and wrists) but may spread to other areas, characteristically on the palms and soles

60. ROCKY MOUNTAIN SPOTTED FEVER
IMPLEMENTATION
Vigorous supportive care
Administer antibiotics as prescribed
Teaching regarding protection from tick bites

61. ENTEROBIASIS (PINWORM)
AGENT
Enterobius vermicularis
SOURCE
Universally present in temperate climatic zones
Eggs are ingested or inhaled (eggs float in the air), hatch in the upper intestine, mature in 2 to 8 weeks, and migrate to the cecal area; females then mate, migrate out the anus, and lay eggs

62. ENTEROBIASIS (PINWORM)
TRANSMISSION
Favored in crowded conditions
Ingestion or inhalation of eggs
Hand-to-mouth or fecal-oral route
Contaminated items (pinworm eggs persist in the environment for 2 to 3 weeks)

63. ENTEROBIASIS (PINWORM)
ASSESSMENT
Intense perianal itching, irritability, restlessness, poor sleep, bed-wetting, distractibility, short attention span
In females, the worm may migrate to the vagina and urethra and cause infection

64. ENTEROBIASIS (PINWORM)
IMPLEMENTATION
Identify the worms
Use of a flashlight to inspect the anal area 2 to 3 hours after the child is asleep
Tape test: Transparent, sticky tape is used to obtain a specimen from the child’s perianal area; specimen is collected in the morning as soon as the child awakens and before a bowel movement or a bath

65. ENTEROBIASIS (PINWORM)
IMPLEMENTATION
Enteric precautions
Anthelmintic medications (all household members are treated); course of medication is repeated in 2 weeks following the first course to prevent reinfection
Teach home care measures to prevent reinfection

66. IMMUNIZATIONS GENERAL CONTRAINDICATIONS Severe febrile illness
Live virus vaccines are generally not administered to anyone with an altered immune system
Allergic reaction to a previously administered vaccine or a substance in the vaccine

67. HEPATITIS B VACCINE (Hep B)
Protects against hepatitis B
All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge
The first dose of hepatitis B vaccine may also be given by age 2 months if the infant’s mother is HBsAg-negative
Only monovalent hepatitis B vaccine can be used for the birth dose

68. HEPATITIS B VACCINE (Hep B)
Monovalent or combination vaccine containing Hep B may be used to complete the series; four doses of the vaccine may be given if combination vaccine is used
The second dose should be given at least 4 weeks after the first dose, except for Hib-containing vaccine which cannot be administered before age 6 weeks
The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose

69. HEPATITIS B VACCINE (Hep B)
The last dose in the series (third or fourth dose) should not be administered before age 6 months
Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 ml hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites; the second dose is recommended at age 1 to 2 months and the vaccination series should be completed (third or fourth dose) at age 6 months

70. HEPATITIS B VACCINE (Hep B)
Infants born to mothers whose HBsAg status is unknown should receive the first dose of the hepatitis B vaccine series within 12 hours of birth; maternal blood should be drawn at the time of delivery to determine the mother’s HBsAg status and if the test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week)
Contraindication: Anaphylactic reaction to common baker’s yeast

71. DTaP (DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS)
Protects against diphtheria, tetanus, and pertussis
DTaP is administered at 2 months, 4 months, 6 months, between 15 to 18 months of age, and between 4 to 6 years of age
The fourth dose of DTaP can be given as early as 12 months of age, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to 18 months of age

72. DTaP (DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS)
Tetanus and diphtheria toxoids (Td) is recommended at 11 to 12 years of age if at least 5 years have passed since the last dose of tetanus and diphtheria toxoid-containing vaccine
Subsequent routine Td boosters are recommended every 10 years
Contraindication: Encephalopathy within 7 days of administration of previous dose

73. HAEMOPHILUS INFLUENZAE TYPE b CONJUGATE (Hib) VACCINE
Protects against Haemophilus influenzae type b
Hib is administered at 2 months, 4 months, 6 months, and between 12 to 15 months of age
Depending on the brand of Hib vaccine used for the first and second doses, a dose at 6 months of age may not be needed
DTaP/Hib combination products should not be used for primary immunization in infants at age 2, 4, or 6 months, but can be used as boosters following any Hib vaccine

74. INACTIVATED POLIOVIRUS VACCINE (IPV)
Protects against polio
An all-IPV schedule is recommended for routine childhood poliovirus vaccination in the United States
IPV is administered at 2 months, 4 months, between 6 and 18 months, and between 4 to 6 years of age
Cautions: Anaphylactic reaction to neomycin or streptomycin

75. MEASLES, MUMPS, RUBELLA (MMR)
Protects against measles, mumps, and rubella (German measles)
The first dose of MMR is administered between 12 to 15 months of age; the second dose is administered at 4 to 6 years of age
The second dose may be administered during any health care visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months

76. MEASLES, MUMPS, RUBELLA (MMR)
Those who have not previously received the second dose should complete the schedule by the visit at 11 to 12 years
MMR contains minute amounts of neomycin; measles and mumps vaccine, which are grown on chick embryo tissue cultures, are not believed to contain significant amounts of egg cross-reacting proteins

77. MEASLES, MUMPS, RUBELLA (MMR)
CONTRAINDICATIONS
Pregnancy
Known altered immunodeficiency
Allergic to contents of immunization (prior to the administration of MMR vaccine, assess for a known history of allergy to neomycin or related antibiotics)

78. MEASLES, MUMPS, RUBELLA (MMR)
CONTRAINDICATIONS
Presence of recently acquired passive immunity through blood transfusions, immunoglobulin, or maternal antibodies (MMR should be postponed for a minimum of 3 months after passive immunization with immunoglobulins and blood transfusions, except washed blood cells, which do not interfere with the immune response)

79. VARICELLA VACCINE Protects against chickenpox
Varicella zoster vaccine is administered between 12 and 18 months of age
Susceptible children 13 years of age and older (who have not had chickenpox or have not been previously vaccinated) need 2 doses, given at least 4 weeks apart

80. VARICELLA VACCINE CONTRAINDICATIONS Pregnancy
Immunocompromised individuals
Children receiving corticosteroids

81. PNEUMOCOCCAL VACCINE (PCV)
The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2 to 23 months and for certain children aged 24 to 59 months
Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups

82. HEPATITIS A VACCINE
Recommended for use in selected geographical areas and for certain high-risk groups

83. INFLUENZA VACCINE
Recommended annually for children who are at least 6 months of age with certain risk factors (including, but not limited to, asthma, cardiac disease, sickle cell disease, HIV, and diabetes mellitus) and can be administered to all others wishing to obtain immunity