1. Communicable Disease

2. Communicable Diseases
Diseases with high transmission rates transmitted by contact with body fluids
directly transmitted- acquired from a person or vector
indirectly transmitted- contact with contaminated objects
Viruses are the leading cause of most pediatric communicable diseases

3. Communicable Diseases
The poor hygiene behaviors of young children promote the transmission of infectious diseases
The fecal-oral and respiratory routes are the most common sources of transmission in children
Young children may not wash their hands after toileting unless closely supervised

4. Immunizations

5. Why Immunize? We are a mobile society
Diseases do not stop at geopolitical borders
Children in the United States continue to get diseases that are vaccine preventable
There continues to be newly emerging and re-emerging infectious diseases
Healthy People 2020 goal to have 100% elimination of vaccine preventable diseases

6. Immunizations
Prevention of any illness is always better than treatment
Vaccines are the single best technique for prevention
Vaccines are the safer choice to getting the disease

7. Advisory Committee for Immunization Practices (ACIP)
Sets the recommended schedule for immunizations
Infants and Children 0-6
Children and Adolescents 7-18
Catch-up schedules (1 month behind)
Schedule is reviewed yearly to reflect current recommendations for licensed vaccines.

9. Children 0-23 months DTaP (4 doses) Hib (4 doses) PCV (4 doses)
Hep B (3 doses)
IPV ( 3 doses)
Hep A (2 doses)
Influenza (2 doses yearly)
MMR (1 dose)
Varicella (1 dose)
Up to 24 injections in 2 years
As many as 5 injections in a single visit

10. 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 days post vaccine (usually in older children)

11. Side Effects All vaccines could produce side effects
CDC publishes Vaccine Information Sheets (VIS)
Most side effects are minor and are related to the administration, not the vaccine
Soreness and swelling at injection site
Low-grade fever

12. Contraindications
Severe allergic reaction (anaphylaxis) after a previous dose or to a vaccine component
Encephalopathy not attributable to another identifiable cause within 7 days of administration
Pregnancy (live vaccines)
Severe immunodeficiency (live vaccines)

13. Adverse Events Vaccine Adverse Event Reporting System (VAERS)
Detect new, unusual, or rare vaccine adverse events
Monitor increases in known adverse events
Identify potential patient risk factors for particular types of adverse events
Identify vaccine lots with increased numbers or types of reported adverse events
Assess the safety of newly licensed vaccines

14. Vaccine Information Statements (VIS)
National Childhood Vaccine Injury Act of 1986
Law states parents/legal guardians must be informed about the benefits and risks of vaccines before administration
Legal mandate VIS must be offered electronically or paper copy
The law requires providers to use those developed by CDC (do not change a VIS or make your own VIS)

15. Vaccine Information Statements (VIS)
National Childhood Vaccine Injury Act of 1986
Law states parents/legal guardians must be informed about the benefits and risks of vaccines before administration
Legal mandate VIS must be offered electronically or paper copy
The law requires providers to use those developed by CDC (do not change a VIS or make your own VIS)

16. Informed Consent
Parent or legal representative sign a separate “informed consent” form if it is required by state
VISs are not informed consent forms

17. Safe Storage and Handling
Store vaccines at the recommended temperatures according to the manufacturer’s guidelines IMMEDIATELY upon arrival
Vaccine shipments should be delivered when staff is available to unpack and store the vaccine properly
Store vaccine in storage units designated specifically for biologics
Post “Do Not Unplug” signs next electrical outlets

18. Safe Storage and Handling
Prepare vaccines at the time the vaccine is administered
Reconstitute immediately prior to injection
Store diluent according to the manufacturer’s instructions

19. Atraumatic care
Select needle of adequate length-longer needles inserted at 90 degrees is best
Select proper site
VL infants
Deltoid > 18 months
Minimize pain
EMLA cream
Distraction

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

21. Communicable Diseases

22. Communicable Disease Viral or Bacterial
Most are transmitted by respiratory secretions in early prodromal period
Communicable disease can cause serious complications and death
Infected children can transmit disease to pregnant women and cause fetal disease, disability
Many are Diseases are Vaccine Preventable

23. Nursing Responsibilities
Assessment
Identify recent exposure
Identify prodromal symptoms
symptoms that occur early in disease
Locate immunization history
Confirm history of having the disease

24. Nursing Responsibilities
Implementation
prevent spread-isolation
reduce risk of cross contamination
prevent complications
provide comfort

25. Viral Infections

26. Viral Infections Fifth’s Disease Roseola Varicella Ruebola Mumps
Non- Preventable Viral Disease
Vaccine Preventable Viral Disease
Fifth’s Disease
Roseola
Varicella
Ruebola
Mumps
Rubella

27. Fifth’s Disease
Parvovirus

28. Fifth’s Disease
Affects any age child, usually preschool or early school age
Common disease as no vaccine is available
Believed once had disease will not acquire again
Moderately uncomfortable symptoms

29. Symptoms No prodromal symptoms
Begins with rash of erythema on cheeks “slapped face appearance”-classic for fifth disease
Next 24 hrs high fever, lethargy, n/v, abd. pain, cervical lympadnopathy

30. Symptoms Within the week, maculopapular red spots appear
Symmetrically on upper and lower extremities has a lace-like appearance
Rash subsides in a few days but reappears if skin is irritated (sun, heat, cold)

31. Management
Management of other symptoms (fever, pain, nausea, vomiting)
Explain the stages of rash development to parents
Isolation during facial rash stage
The immune-competent child can return to school or daycare once the body rash has appeared

32. Roseola

33. Roseola Disease of younger children
Common disease as no vaccine is available
Rarely affects children >3 years
Believed once had disease will not acquire again
No uncomfortable symptoms except for high fever

34. Symptoms
Prodromal Symptoms of persistent high fever for 3-4 days in a child who appears well
Then drop in fever to normal and rash appears that identifies roseola
Rash is a rose-pink macules first on trunk, spread to neck, face, extremities, not itchy, lasts 1-2 days

35. Management Antipyretics, analgesics
Isolation not necessary once rash appears
Since fever is very high can have febrile seizures

36. Varicella
(Chicken Pox)

37. Varicella Affects unvaccinated child of any age
Vaccine available for children age 12 months and older
Extremely uncomfortable disease that lasts for weeks
Death is rare but can be caused by blockage of GI track, especially in infants and immunocompromised children

38. Symptoms Prodromal period slight fever, malaise, anorexia
Next 24 hours highly itchy rash primarily over trunk can spread all over skin and mucus membranes, GI track, genitalia
The key to diagnosis is varying stages of rash

39. Symptoms
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
vesicle
macule
papule

40. Management
Communicable 1 day before eruption of vesicles to 6 days after first crop of vesicles have formed
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, skin care (extremely itchy rash)
Treat secondary complications (bacterial infections from scratching)

41. Rubeola
Measles

42. Rubeola Affects unvaccinated children of any age
Vaccine available for children age 12 months and older
(First “M” in MMR)
Extremely uncomfortable disease that lasts for weeks
Death is common especially in infants and immune-compromised children as many cases spread to brain and cause encephalitis

43. Symptoms Prodromal period in first 24 hours
Fever, malaise, cough, coryza, conjunctivitis
Next 48 hours first ‘rash’ that identifies rubeola
“Koplik spots” (small, irregular, red spots with minute bluish-white center) first seen on buccal mucosa

44. Symptoms Raised erythema rash on face that spreads downward
Discrete, then turns confluent on the third day
Other respiratory symptoms persist

45. 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

46. Mumps

47. Mumps Affects unvaccinated children of any age
Vaccine available for children age 12 months and older
(Second “M” in MMR)
Moderately uncomfortable disease
Death is not common however swelling causes extreme difficulty to swallow, leads to dehydration

48. Mumps
Prodromal symptoms of fever, headache, maliase, anorexia, and earache aggravated by chewing
On 3rd day classic symptoms of parotitis (enlarged parotid gland), unilateral or bilateral, pain, tenderness
No rash

49. Management Analgesics for pain Antipyretics
Isolation until swelling resolves
Bed rest
Soft diet
Cold compress to neck

50. Rubella
German Measles

51. Rubella Affects unvaccinated children of any age
Vaccine available for children age 12 months and older
(“R” in MMR)
Mildly uncomfortable disease
Death is not common

52. Symptoms
Prodromal symptoms of low grade fever, HA, malaise, cough, sore throat
Identifiable rash begins on face which rapidly spreads downward to neck, arms, trunk and legs
By end of first day body is covered with pinkish-red maculopapules
Slightly itchy
Rash disappears in same order as it appeared gone by 3rd day

53. Management Antipyretics Comfort measures-slight itchy rash
Isolation until rash disappears
Avoid contact with pregnant women

54. Bacterial Infections

55. Bacterial Infections Diphtheria Pertussis Scarlet Fever
Vaccine Preventable Bacterial Disease
Vaccine Preventable Bacterial Disease
Diphtheria
Pertussis
Scarlet Fever

56. Diphtheria

57. Diphtheria Affects unvaccinated children of any age
Vaccine available for children age 2 months and older
(“D” in Dtap)
Serious respiratory involvement
Death is common due to airway obstruction from laryngeal swelling

58. Symptoms yellow nasal discharge may have epistaxis sore throat
hoarseness with cough
enlarged lymph nodes
low grade fever
increase pulse
malaise

59. Management Diagnosed by culture of discharge strict isolation
antibiotics-penicillin
complete bed rest
trach if obstructed airway
suctioning

60. Pertussis
Whooping Cough

61. Pertussis Affects unvaccinated children of any age
Vaccine available for children age 2 months and older
(“P” in Dtap)
Serious respiratory involvement
Death is common due to airway obstruction

62. Symptoms Prodromal symptoms begins with cough and congestion
Progresses into a dry, hacking cough that becomes severe, worse at night
Cough is short and rapid followed by sudden inspiration and whooping

63. Symptoms Cheeks flush, eyes bulge, tongue protrudes
Thick secretions, often vomits
Sick for 4-6 weeks
for sound and video

64. Management Hospitalization for infants or children who are dehydrated
Bed rest
Increase fluids
Antibiotics-macrolides
Suctioning
Humidifier
Observe for airway obstruction (restlessness, retractions, cyanosis)

65. Scarlet Fever

66. Scarlet fever
Bacterial infection (strep), often sequela to strep throat
Affects mainly schoolage children and adolescents age 5-15 who are susceptible to strep throat
Isolation not necessary after 24 hours on antibiotics
No vaccine
Moderately uncomfortable symptoms

67. Symptoms
Prodromal symptoms of abrupt high fever, high pulse, vomit, headache, Malaise, chills, abdominal pain
Followed by
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”

68. Symptoms
By 4th or 5th day white coat sloughs off leaving prominent papillae = “red strawberry tongue”
Rash appears of red, pin head sized lesions, rash is intense in folds and joints, flushed cheeks

69. Management Diagnosis made by positive throat culture and ASO titer
respiratory isolation x 24 hours
7-10 days of penicillin
analgesics for sore throat

70. Practice Questions!

71. Which of the following statements indicates that a parent understands the treatment for his/her child who has fifth disease? (Select All That Apply) 1. “I will give antibiotic for the full 10 days” 2. “No antibiotic is needed, as this is a viral infection.” 3. “I will apply antibiotic cream to her rash twice a day.” 4. “My child can go back to school when the body rash appears”. 5. “If my child had the vaccine, she wouldn’t have go gotten sick”

72. Fill in the Blank
The nurse is explaining the vaccine schedule to a parent of a newborn. The nurse evaluates parental understanding if the parent states the child will need _____ DTaP vaccines by age 24 months.

73. A mother brings her infant to the pediatrician because the baby has had a high fever for 3 days and then developed a rash. The nurse examines the baby to find light pink macules on trunk, neck, face, and extremities. The nurse suspects the baby has:
1. Rubeola
2. Rubella
3. Roseola
4. Scarlet Fever

74. If a 2 year old child was fully immunized or “up to date”, the child has a very low chance of getting which infection: (Select All that Apply)
Diptheria
Varicella
Roseola
Pertussis
Rubella