Infectious Diseases and Vaccines

Immunity

The body’s resistance to the effects of harmful agents (pathogens)

1. Body recognize

2. Body ability to destroy and remove

How does the body kill pathogens?

Inflammation

Non specific response causes damage to tissues and cells, so the body delivers fluid, blood, and nutrients to the area to try to eliminate the pathogen and repair damage

Immunity and Inflammation

What does the body need both of to fight off bacteria?

Neutrophils

First line of defense against invading organisms

Lymphocytes

B & T lymphocytes; B cells produce antibodies

• Both have memory of antigens

B lymphocytes

Which lymphocyte is produced in the bone marrow?

T lymphocytes

Which lymphocyte is produced in the thymus gland?

Antibodies (Immunoglobulins)

Proteins produced by B cells to remove pathogens; viruses and bacteria

• Specific to an organism

1. Passive Immunity

2. Active Immunity

What are the two types of immunity?

Passive immunity

Temporary (short term), no immunologic memory

1. Natural: Maternal (IgG for 3-4 months)

2. Artificial: Exogenous sources (eg. IVIG infusion); helps boost immunity to get through sickness

What are the two types of passive immunity?

Active Immunity

Generates memory, minimize severity and response but doesn’t totally prevent

• Natural: Infection

• Artificial: Vaccination; gives body immunity for a significant period of time (low dose)

What are the two types of active immunity?

• Immune system is still developing (more susceptible to infections)

• Decreased inflammatory reponse (not the same obvious signs)

• Immunoglobulins not at adult levels until school-age (give antibody)

• Decreasing passive immunity from Mom

• Incomplete immunization protection (not getting all their shots)

Whta are kids at a higher risk for getting sick?

Are unable to temperature regulate (may be hypothermic)

What might the inflammatory response be in infants?

Breast feed (IgA)

Where do infants also get their immunity?

1. Health hx

2. Physical exam

3. Lab and dx testing

What are the three assessments that you should do on a child with an infectious disease?

• Exposure

• Immunization status (risks?)

• s/s disease and it’s progression (differentiates)

What are the questions to ask in a child’s health hx for infectious diease?

• Observe child’s behavior

• Assess hydration status

• Measure VS

• Accurately describe rashes (exanthem)

• Assess lesions or wounds

What is part of the physical examination for a child with infectious disease?

• CBC (WBC, etc.)

• Inflammatory markers (CRP, ESR)

• Cultures (blood, urine, stool, wound)

What are the labs and dx testing for a child with infectious disease?

1. Incubation

2. Prodrome

3. Illness

4. Convalescence

What are the stages of infectious disease?

Incubation

Time from entrance of pathogen into the body to appearance of first sx; during this time, pathogens GROW and MULTIPLY

Prodrome

Time from onset of NONSPECIFIC SX such as fever, malaise, and fatigue to more specifc sx

Illness

Time during which child demonstrates HALLMARK S/S specific to an infection type

Convalescence

Time when ACUTE sx if illness disappear (recover)

When child is CONTAGIOUS

What period of time in the child’s sickness should the parent know about?

• Handwashing

• Adequate immunizations

• Judicious AB use (good judgement and carefully)

• Isolation precautions (Tier 1 and 2)

What are the ways to prevent the spread of disease?

Take all the given AB

What is important to educate patients about their AB?

Standard precautions

What is tier 1 standard precautions?

Transmission based precautions

What is tier 2 standard precautions?

1. Rubeola (measles)

2. Rubella (German measles)

3. Varicella (chicken pox)

4. Parotitis (mumps)

5. Pertussis

What are the types of infectious diseases kids could get?

Virus

What type of infection is Rubeola, Rubella, Varicella, and Parotitis?

Airborne, Droplet (negative pressure room)

What are the precautions/transmission for Rubeola?

• 3-5 days before rash

• Until 4-6 days after rash

What is the contagious period for Rubeola?

• Prodrome: fever, cough, coryza (acute inflammation of mucous membranes), conjunctivitis

• Koplik spots (bluish, white spots on inside of cheek)

• Rash

What are the s/s of Rubeola?

Before rash

When do Kolipk spots appear?

Starts after the prodromal phase at the HEAD and moves DOWN and OUTWARD

How does the rash start in Rubeola?

A week

How loong does the rash last in Rubeola?

If there are no hx of shots, a more aggressive approach might be used

Why should you know the immunization status of infectious diseases?

• Otitis media (upper congestion, ear infection)

• Encephalitis (blindness, deaf, death)

What are the complications of Rubeola?

• Prevention

• Airbrone precautions until 4-6 DAYS AFTER onset of rash

• Supportive and comfort care

• Possible VITAMIN A supplementation

• If higher risk, give IV IG boost

• If already exposed, give vaccine within 72 hours

What is the nursing management of Rubeola?

• Antipyretics

• Antiprurtics

• Bedrest

• IV FLUIDS

• Skin/eye care

• Cool mist

• HUMIDIFER

What is the supportive and comfort care for Rubeola?

Does not prevent, but may help SEVERE DISEASE

What does vitamin A NOT prevent?

Droplet precautions; also transmitted TRANSPLACENTALLY

What are the precautions/transmission for Rubella?

• 7 DAYS BEFORE

• Up to 14 DAYS after onset of rash

What is the contagious period for Rubella?

• Pink, fine rash begins on FACE spreads HEAD to TOE

• Less intense than measles

• Low grade fever

• Lymphadenopathy

• Mild pruritis

• Polyarthralgia (joint pain) (adolescents)

What are the s/s of Rubella?

3 days

How long does the rash last in Rubella?

• Prevention

• Supportive and comfort measures

• PREGNANT women should AVOID exposure

What is the nursing management of Rubella?

Can lead to miscarriage or congenital malformations

Why should Rubella be avoided in pregnancy?

• Encephalitis

• Thrombocytopenia

What are the complications of Rubella?

• Airborne

• Direct (later stage)

• Mom to fetus

What are the three routes of transmission for Varicella (chicken pox)?

• 1-2 DAYS before rash

• Until ALL LESIONS CRUSTED OVER

What is the contagious period of Varicella?

Rash; scalp, face, trunk

• Rash → PAPULES with FLUID → scarring

• Can appear at different stages at different parts of the body

What are the s/s of Varicella?

• LATENT infection remains

• Secondary bacterial infection

• Encephalopathy

• Death

What are the compliations of Varicella?

Shingles

What does varicella become in adulthood if caught in childhood?

• Prevention (follow VACCINATION schedule)

• Airborne/contact precautions

• Supportive and comfort care (nails short, hand washing)

• ANTIVIRAL THERAPY and/or VZIG for high-risk, immunocompromised pts.

What is the nursing management for Varicella?

Paramyxovirus

What is the name of the Parotitis (mumps) virus?

• Saliva (contact)

• Droplet

What is the mode of transmission of Parotitis?

• SEVERAL DAYS before swelling of glands

• Until 6-9 DAYS after

What is the contagious period of Parotitis?

• Fever

• Earache

• Malaise

• GLAND SWELLING

• Pain

What is the s/s of Parotitis?

• Hearing impairment

• Meningitis

• Swollen testicles (orchitis) in boys

What are the complications of Parotitis?

• Prevention

• Droplet (isolation)

• Supportive care (eat and drink)

• Soft diet

• Pain manage

• Fluid and hydration

What is the nursing management of Parotitis?

Bacteria (Bordetella pertussis)

What type of infection if Pertussis?

Children <1 yrs old

At what age is Pertussis most dangerous?

• 1-2 WEEKS URI (upper respiratory infection) (sore throat, stuffy nose, sneeze, malaise)

• Then PAROXYSMAL COUGHING (“whoop”, can’t stop) up to 4 WEEKS

What are the s/s of Pertussis?

OVER SEVERAL MONTHS

How long is convalescence for Pertussis?

• Contagious if untreated (URI to a month after)

• 5 DAYS after not continuing AB

What is the contagious period for Pertussis?

• Pneuomia

• Hypoxia

• Otitis media

• Meningitis

• Death

What are the complications of Pertussis?

• Prevention (follow VACCINATION schedule)

• Course of AB

• Provide RESPIRATORY support (frequent SUCTIONING, HUMIDIFIED O2)

• Enourage fluids

• Reassure and edu fam

• Droplet precautions

• Parents should get TDAP

What is the nursing management for Pertussis?

• Live attenuated (weakened living organisms)

• Inactivated (dead organisms, incapable of reproducing)

• Toxoid

• Conjugate

• Recombinant

What are the types of vaccines?

Pt. has healthy immune system

What should you make sure of before giving a live attenuated vaccine?

1. Diptheria, Pertussis, and Tetanus

2. Haemophilus influenzae Type B (Hib)

3. Polio

4. Hepatitis B (Hep B)

5. Pneumococcal (PCV15, 20)

6. Rotavirus

What are the immunizations for infants?

<7

What ages should get DTaP?

Older children and adolescents

What ages should get Tdap?

• Meningitis

• Epiglottis

• Septic arthritis

What are the life threatening illnesses if children UNDER 5 don’t take Hib vaccine?

• Before D/C from hx

• At birth

When should you give Hep B vaccine?

• Pneumonia

• Sepsis

• Meningitis

What are the life threatening illnesses if children UNDER 2 don’t take Pneumoccocal vaccine?

Rotavirus

LIVE vaccine, given by ORAL rout to infants

Severe gastroenteritis

What can the Rotavirus cause?

AFTER 8 months of age (older kids can tolerate virus)

When is Rotavirus not given?

1. Measles, Mumps, and Rubella (MMR)

2. Varicella (chicken pox)

3. Hepatitis A (Hep A)

Immune systems are higher by 1 year

What are the immunizations of toddlers?

2 DOSES given to children >12 MONTHS of age

What is the number of doses given in all immunizations for toddlers?

• DTaP 5TH DOSE to finish series

• Inactivated POLIO 4TH DOSE to finish series

• MMR and VARIVAX (varicella) 2ND DOSES to finish series

What are the immunizations for young children (PRE-K to 5 YEARS)?

DTAP and Polio

Which vaccines inactivated can be given BEFORE and AFTER 12 months of age?

MMR and VARIVAX (varicella)

Which vaccines LIVE IS ONLY given AFTER 12 months of age?

1. Meningcoccal (MCV4, A,C,W,Y strains)

2. Human Papillomavirus (HPV)

3. Tetanus, diphtheria, pertussis (Tdap)

What are the vaccines for older children and adolescents?

16 YEARS

At what specific age can you give the meningcoccal vaccine?

2 doses

How many doses is the meningcoccal vaccine?

Meningitis and sepsis

• 10-12% infected persons die, 20% survivors supper long term consequences

What does the Neisseria meningitidis cause?

HPV

What virus is most common in adolescents and young adults who are SEXUALLY active?

Genital warts that can lead to cervical cancer

What are the complications HPV?

1. Influenza

2. Covid-19

What are the vaccines that can be given to any age ANNUALLY?

Influenza vaccine

• Universally recommended ≥6 MONTHS of age

• QUADRIVALENT

Initially need 2 VACCINES, 1 MONTH apart

What type of influenza vaccine is recommended at <9 YEARS?

0.25mL

How many mL should children 6-35 MONTHS get?

0.5mL

How many mL should children ≥36 MONTHS get?

• Precautions increase the RISK of adverse reaction (benefits weighed against risk) but can STILL BE GIVEN

• Contradictions are things that could harm the patient and would be WITHHELD or NOT GIVEN PERMANENTLY

What is the difference between precaution and contradiction?

• Seizures

• Prolonged crying

• High fever (pertussis)

• Mild-moderate illness

What might be some precautions to immunizations?