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: 1.prevent spread 2.reduce risk of cross contamination 3.prevent complications 4.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 2 nd “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 3 rd 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 3 rd 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 4 th or 5 th 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

51. What has…. Pinkish-red maculopapules on face rapidly spreads downward to neck, arms, trunk and legs Rash disappears in same order as it appeared in 3 days

52. What has… White, curd-like plaques on tongue, gums, buccal mucosa (not easily removed) Diaper area lesions are bright red

53. What has… Red, pin head sized lesions Intense in skin folds and joints Flushed cheeks

54. Erythematous, oozing, crusting on cheeks, forehead, scalp, flexor surfaces of arms and legs Can become scaly Plaques become excoriated