Childhood Communicable Diseases Topics Measles Mumps Rubella Varicella Pertussis Mononucleosis Childhood communicable diseases Most recover without difficulty Declined due to immunizations The use of antibiotics has reduced serious secondary complications General Nursing Care Management Prevent spread Primary prevention Immunizations Control spread to others Reduce risk of cross-contamination Good handwashing Follow facility policies for infection control Prevent complications Children with immunodeficiency receiving steroids/immunosuppressive therapy/immunologic disorder Provide Comfort Most communicable diseases cause skin manifestations Measures can include cool baths (usually without soap) and lotions (calamine) Three Levels of Prevention Primary Prevention: ◦ a disorder is actually prevented from developing. Vaccinations and counseling to change high-risk behaviors Secondary Prevention: ◦ disease is detected and treated early, can involve screening programs, such as mammography Tertiary Prevention: ◦ an existing, usually chronic disease is managed to prevent complications or further damage, a person who has had a stroke may involve taking aspirin to prevent a second stroke from occurring Measles (Rubeola) Viral disease (Rubeola virus) ◦ Usually by direct contact with droplets of infected person by respiratory tract secretions, blood and urine of an infected person ◦ Incubation period: 10-20 days ◦ Most contagious: 4 days before to 5 days after rash appears but mainly during prodromal stage Clinical Manifestations ◦ Prodromal Stage: Fever and malaise followed in 24 hour by coryza, cough, conjunctivitis, Koplik spots. ◦ Rash appears 3 – 4 days after onset of prodromal stage ◦ Erythematous maculopapular eruption on face and gradually spreads downward Complications ◦ Encephalitis (rare but high mortality) and Pneumonia Therapeutic/Nursing Management ◦ Vitamin A ◦ Supportive bedrest/antipyretics during febrile period ◦ Maintain isolation until fifth day of the rash ◦ Keep child from rubbing eyes Mumps Viral disease (Paramyxovirus) ◦ Infection of the parotid gland by direct contact with or droplet spread of saliva. ◦ Incubation period: 14-21 days ◦ Most contagious: immediately before and after swelling of glands Clinical Manifestations ◦ Prodromal: Fever, headache, malaise and anorexia for 24 hrs followed by earache that is aggravated by chewing ◦ Parotitis: By third day, unilateral or bilateral enlargement Complications: ◦ Orchitis (Male); Oophoritis (Female) Therapeutic Management ◦ Symptomatic and Supportive ◦ Analgesics for pain, Antipyretics for fever, encourage rest and fluids, cool compresses ◦ Maintain isolation during communicability; Droplet and Contact Rubella (German Measles) Viral Disease (Rubella Virus) ◦ Primarily spread by nasopharyngeal secretions, blood, stool and urine. ◦ Incubation period: 14-21 days ◦ Most contagious: 7 days before to about 5 days after appearance of rash Clinical Manifestations ◦ low grade fever, headache, malaise, anorexia, mild conjunctivitis, coryza, sore throat, cough and lymphadenopathy for 1 to 5 days and rash appears ◦ Rash: first appears on face and rapidly spreads downward, disappears in same order and rash gone by third day. ◦ Discrete pinkish-reded maculopapular exanthema Complications ◦ Teratogenic effect on fetus during pregnancy Therapeutic/Nursing Management ◦ Avoid contact with pregnant women ◦ Supportive measures include antipyretics for fever and analgesics for discomfort, ◦ Droplet precautions Chickenpox (Varicella) Viral Disease (Varicella zoster virus) ◦ Spread by direct contact, droplet, and contaminated objects ◦ Secretions of the respiratory tract ◦ Fluid-filled skin lesions (lesser degree) ◦ Incubation Period: 2-3 weeks, usually 14-16 days ◦ Most contagious: 1 day before lesions to 6 days after vesicular lesions crust over Clinical Manifestations ◦ Slight fever and anorexia for the first 24 hours, then highly pruritic rash develops ◦ Rash: ◦ Centripetal: rash starts on the chest/back and spread to the entire body ◦ 3 stages: Papule to vesicle to crusting over Complications ◦ Pneumonia and encephalitis Therapeutic/Nursing Management ◦ Specific: Antiviral agent – Acyclovir (Zovirax); Intravenous immunoglobulin (IVIG) after exposure in high-risk immunocompromised children ◦ Supportive care: Antihistamines to relieve itching, skin care to prevent secondary infection ◦ Skin care: give bath and change clothes/linen daily, administer topical calamine lotion, keep child’s fingernails short, apply mittens if child scratches, remove loos crusts that rub and irritate skin, teach to apply pressure to pruritic are rather than scratching ◦ Avoid use of aspirin since it can trigger Reye’s syndrome particularly in children with Varicella Pertussis Whooping Cough Bacterial Disease (Bordetella pertussis) ◦ Spread by discharge from respiratory tract through direct contact or droplet spread; can be indirect contact with freshly contaminated articles. ◦ Incubation period: 6-20 days, usually 7-10 days ◦ Most contagious: during catarrhal stage before onset of paroxysms Clinical Manifestations ◦ Catarrhal Stage: symptoms coryza, sneezing, lacrimation, cough and low-grade fever, symptoms continue for 1-2 weeks; cough becomes worse ◦ Paroxysmal stage: Cough most common at night, consists of short, rapid coughs followed by sudden inspiration associated with high-pitched “whoop”; cheeks become flushed or cyanotic, eyes bulge and tongue protrudes during paroxysm; vomiting frequently follows the attack; generally last 4-6 weeks ◦ Cough can last up to 6 to 10 weeks Complications ◦ Pneumonia (usually cause of death in younger children); weight loss, urinary incontinence and rib fractures Therapeutic/Nursing Management ◦ ◦ ◦ ◦ Specific: Antibiotic therapy - Macrolides Supportive: May need hospitalization who are dehydrated and have complications; adequate fluids Maintain isolation during catarrhal stage Encourage compliance with antibiotic therapy for household contacts Whooping Cough in an Adult by New England Journal of Medicine Infant girl with whooping cough by Mayo Clinic Infectious Mononucleosis Viral Disease (Epstein Barr Virus) ◦ Can be typically transmitted by direct contact through bodily fluids. Can also spread by blood, semen, blood transfusion, or organ transplantation ◦ Incubation period: 30 to 50 days ◦ Contagious: period of communicability is unknown Clinical Manifestations ◦ Fever, exudative pharyngitis with petechia, lymphadenopathy, hepatosplenomegaly, and increase in atypical lymphocytes; can be mild to severe, and symptoms can last from 10 days to 6 weeks. Complications ◦ Meningitis, encephalitis, pneumonitis, and ruptured spleen Therapeutic/Nursing Management ◦ Specific: Short course of corticosteroids may be recommended ◦ Supportive measures: mild analgesic, rest is encouraged, ◦ Antibiotics are only used if a secondary infection, not viral; may develop a nonallergic maculopapular rash ◦ Strenuous activity and contact sports should be avoided for 21 days after the onset of symptoms. ◦ Clearance to participate in contact sports is appropriate after 4 to 6 weeks if asymptomatic and has no splenomegaly. References Olshan, S., Perry, M., Hockenberry, M., Cashion, M., Alden, K., Olshansky, E., & Lowdermilk, D. (2023). Maternal Child Nursing Care (7th ed.). Elsevier Health Sciences. https://pageburstls.elsevier.com/books/9780323825856
