communicable disease

what is active (adaptive immunity)

- antigen/antibody to disease or vaccines

- natural immunity

what is passive immunity

- person is given antibodies rather than making from own immune system, only lasts a few weeks/mo

- ex: mother to fetus, immunoglobulin

why are children more vulnerable to communicable disease

- thinner skin

- immature immune system

- passive immunity from mother - lasts aprox 6mo, breastfeeding extends

- less acquired immunity

- immunizations incomplete

- poor hygiene behaviors

communicability period

- how long your contagious

incubation period

- how long it takes for s/s to appear after exposure

prodromal

- not feeling well, appear before main s/s

reportable diseases

- disease important to public health, report to local health dept

- allows for collectioxan of statistics on disease trends and outbreaks

vaccines for children program

- free vaccines to medicaid eligible, uninsured, underinsured, native american/alaskan native children

when to give vaccines

- most series begin from birth-2mo

- completed by 18 mo

- boosters in kindergarten and 6th grade

- delaying/spacing out vaccine leaves children vulnerable longer, increases visits and stress for the child, no evidence of fewer adverse rxn

- if series incomplete, dont restart just give missed doses, check state registry

routes for vaccines

- various routes

• more than one shot in same extremity is ok, just 1 in inbetween

key features vaccines

- document route, site, date, and lot number

- ky immunization certificate

- parents can refuse immun. for medical, religious, or philosophical exception

- travel vaccines: cdc website

- a child who has had a bone marrow transplant would need to be revaccinated. the prepartion process completely wipes out immune system and erases prior imunity

what is national childhood vaccine injury act 1986

• Limits litigation

• Give guardian Vaccine Information Statement (VIS)

• Vaccine adverse event reporting system - VAERS

• can sue but only for certain art

rxns to vaccines

- local rxns: erythema, swelling, tenderness at injection site

- systemic rxns: low grade fever, chills, fatigue, muscle and joint aches

- behavioral changes: drowsiness, fussiness, decreased appetite

- immune system stimulation is norma

- acetaminophen can be given prior to vaccine

- vasovagal response: fainting, most common in adolescents

- rarely: site infection, severe inflammation, allergy/anaphylaxis to vaccine components

true contraindications to vaccination

- hx of anaphylactic or severe rxn to a vaccine or one of its components

- moderate or severe illness

- no live attenuated vaccines (mmr, c-pox, rotavirus, flu mist,) if immunocompromised or pregnant **

- post pone vaccine for 3mo after immunoglobin admin or blood transfusion (passive immunity may affect immune response)

ok to vaccinate if

- mild illness/low grade fever

- hx of mild local rxn

- on antibiotics

- premature

10 myths about vaccines

MYTH 1: Infant immune systems can’t handle so many vaccines

• Babies exposed to may bacteria/viruses each day, immune has enough antibodies in the blood to handle approx. 10,000 vaccines at one time.

MYTH 2: As long as other children are getting vaccinated, mine don't need to be.

• Unvaccinated people pose risks to infants too young to be immunized, people who are immune compromised, and to healthcare workers.

• More people with immunity gives us herd immunity (having disease or vaccine).

MYTH 3: Now that major illnesses have largely disappeared, we don't need vaccines anymore.

• Illness are “just a plane ride away”, we still see outbreaks

MYTH 4: Vaccines cause autism and other disorders; incorrect bc studies

MYTH 5: My baby might get the disease it's supposed to prevent.

• Not possible from killed vaccines, small risk from live attenuated vaccines but would be much less severe, risk if has immune disorders

MYTH 6: Vaccines can contain preservatives that are dangerous.

• Thimerosal is a type of mercury that has not been found to cause harm other than minor redness and swelling.

MYTH 7: You shouldn't give a vaccine to a child who has a cold.

• Children with a mild illness or fever can receive vaccines

MYTH 8: Chickenpox isn't a big deal.

• Severe infections, pneumonia, and encephalitis are complications. Prior to the vaccine 11,000 Americans hospitalized and 100+ died each year (‘90-’96) per CDC

MYTH 9: Vaccines can provide 100 percent disease protection.

• No vaccine is 100% and some immunity wanes over time.

MYTH 10: It's best to wait until children are older before starting to give them vaccines.

• Children are most at risk when their immune systems are immature.

*if parents choose not to vaccinate

• providers can ask them to leave their practice

• providers should give info. on risks

viral communicable disease

- most common cause of illness in children

- very contagious

- usually short lived but can cause serious comp

- children and elderly at highest risk

- tx often limited to symptomatic tx

- may lead to secondary infections

- many viruses cause rashes: if child admitted to hospital w undiagnosed exanthem (rash), strict isolation is instituted until dx confirmed; rashes are often confused for each other

- home tests available for covid, flu, rsv, and mono (blood test)

coronavirus

large family of viruses that cause mild (common cold) to severe (mers, sars, covid) ilness

COVID-19

• Generally, symptoms in kids & babies are milder than in adults, kids under 1 have most issues

• Children age 6 mos and older can receive Covid-19 vaccine

• Treatment: Antivirals

antivirals for kids covid

- paxlovid approved for 12+

- remdisivir: children 28 days and older or at least 7 lbs

multisystem inflammatory syndrome in children

- different body parts can become inflamed, including heart, lungs, kidneys, brain, eyes, or gi organs after current or recent covid infection

- can happen up to 6 wks after covid

- similar to kawasaki disease

- watch for fever, pus, stomach pain, bloodshot eyes, vomiting, diarrhea, dizziness (low bp), skin rash

what is kawasaki disease

acute febrile illness that causes inflammation of blood vessels

what is fifth disease (erythema infectiosum)

- human parvovirus b19

- droplet precautions, good handwashing important

- people who work with children at higher risk

- no vaccine

s/s fifth disease

- mild systemic disease: runny nose, fever, malaise

3 stages:

- 1: slapped cheek appearance, erythema on cheeks first 1-4 days

- 2: maculopapular rash on upper and lower extremities, lasts a week or more

- 3: rash subsided then reappears w heat or cold for weeks

- once rash is noted, child no longer contagious

comp fifth disease

- joint pain and swelling in adults

- may cause death of fetus (not anomalies) in less than 5% of moms infected in 1st half of pregnancy, alert ob hcp if exposed

tx fifth disease

- symptomatic

what is hand, foot, and mouth disease

- coxsackievirus (enterovirus)

- causes inflammation and vesicular lesions in named placed, looks like herpes lesions

- fecal/oral/droplet transmission

- no vaccine

comp hand foot and mouth disease

- child may refuse to eat or drink, may become dehydrated

tx hand foot and mouth disease

- symptomatic

- hygiene

what is infectious mononucleosis

- herpes family (epstein barr virus)

- most common in adolescents

- transmitted through saliva (kissing disease)

- incubation period: 30-50 days

s/s mono

- fever

- sore throat

- tonsillar swelling (can be severe enough to affect drinking, respiration)

- cervical adenopathy

- splenomegaly

- can look like chronic fatigue syndrome or strep throat

tx for mono

- symptomatic

- avoid blow to spleen, no strenuous activity or contact sports for 6-8 wks if enlarged

s/s flu

- fever

- cough

- sore throat

- congestion

- muscle body/aches

- h/a

- diarrhea

- vomiting ( both more common in kids)

comp flu

- pneumonia

- ear infection

- sinus infections

tx flu

- symptomatic

- antiviral drugs decrease duration (start early)

- oseltamivir phosphate (generic and tamiflu) if over 1 yo, bid for 5 days, pill or liquid

flu vaccine key features

- everyone 6mos and older should be vaccinated yearly, pref by end of october

- each year formulated w expected most common strains

- injectable flu vaccine, nasal flu vaccine

- children <9yo the first time they get vaccine, need two doses one month apart

injectable flu vaccine

- made w inactivated viruses, cant get flu from shot

- egg allergy and hx of gullian barre no longer contraindication

- can be given at same time as covid vaccine

- recommended for pregnant women (any trimester)

nasal flu vaccine

- contains live attenuated virus, could possible cause illness in immunocomprimised individuals

- tell provider if pregnent, outside of 2-49 yo range, life threatening allergies, on aspirin, weak immune system, hx of wheezing/asthma, underlying medical conditions, or are for immunocomprimsed person

what is roseola virus

- herpesvirus

- common in infants and toddlers

- contact w secretions, droplet=transmission, 75% of adults are carriers

- no vaccine

s/s roseola virus

- sudden high fever

- malaise

- other s/s illness

- after 3-5 days of a fever, pink maculopapular rash appears and lasts a couple of days

comp roseola virus

- uncommon

- febrile seizure

mumps (parotitis)

• droplet

• vaccine - MMR

s/s mumps (parotitis)

- presents w general illness s/s

- swelling of parotid glands, unilaterally or bilaterally

comp mumps

- meningitis or encephalitis

- orchitis common: 25% post pubescent males affected but sterility rare

- oophoritis and breast inflammation

tx mumps

- symptomatic

- orchitis requires bed rest and intermittent ice packs

what is orchitis

• disease infects testicles causing swelling, pain, soreness, and fever

• often occurs ab a week after disease has broken out

• serious infection that may cause sterility

s/s rubella virus (german measles, 3 day measles)

- viral s/s

- low grade or no fever

- rash starts face/neck and spreads downward

- lasts approx 3 days

comp rubella virus

- usually mild in children and adults

- teratogenic: can cause miscarriage or serious birth defects, highest risk if contracted in 1st trimester pregnancy

- congenital rubella syndrome

congenital rubella syndrome

- deafness

- cataracts

- heart defects

- intellectual disability

- liver/spleen damage

rubella

- airborne and droplets

- mildly contagious

- mmr vaccine

tx rubella

symptomatic

s/s measles (rubeola, red virus)

- viral s/s

- high fever

- rash starts at hairline, spreads downward, lasts 7 days

- 3 cs: cough, conjunctivitis, coryza (runny nose)

- koplik spots: small white spots buccal mucosa 1-2 days before rash (upper palate of mouth)

comp measles

- serious comp - pneumonia, encephalitis (rare)

- can trigger abortions and premature delivery in pregnant mother

transmission measles

- highly contagious

- droplet and airborne

tx measles

- post exposure vaccine w in 72hrs

- immune globulin if pregnant or weak immune system

- vit a supplement can reduce comp in children

vaccine measles

mmr

- 2 doses: 12-15mo and 4-6years

what is respiratory syncytial virus

- causes minor cold symptoms in older kids/adults, more serious in infants < 6mo

- causes inflammation in bronchioles and lots of mucus: rsv bronchiolitis

- nosocomial outbreaks (hospital) common, very contagious, contact and droplet precautions

- can live in nonporous items up to 6 hrs

- most kids get it by 2yo, dont get immunity but severity decreases, most common in winter and spring

dx rsv

- nasal washing or swab - pcr test: polymerase chain rxn

rsv tx

- symptomatic at home, hospitalized for supportive tx if severe

rsv prev measures

- prevent exposure, good handwashing

• vaccine

• monoclonal antibody injection

vaccine rsv

- recommended for: pregnant moms 32-36weeks seasonally sept-jan (abrysvo)

- most infants younger than 8mo born during or entering rsv season

- high risk children between 8 and 19mo old for second season

- 60-74 yo at increased risk (arexy)

- lasts at least 2 years

monoclonal antibody injection rsv

- temporary antibodies

- palivizumab: synagis, monthly through rsv reason

- nirsevimab or clesrovimab: one time lasts 5-6mo

- expensive, not a vaccine

herpes varicella (chickenpox)

- highly pruiritic lesions progress from macules, to papules, to vesicles, all 3 stages exist at once (flat, raised, crusted), crops of pox

- more on trunk/proximal extremities than distal extremities, usually not on palms/soles

comp of chickenpox

- secdonary bacterial skin infection

- encephalitis

- pneumonia

- congenital varicella syndrome (causes birth defects)

how long is chickenpox contagious for? incubation period?

- incubation period: 10-21 days

- period of communicability: contagious 1 day before onset of rash

- contagious until all lesions are scabbed over (5-7days), can get twice if first case was very mild

varicella vaccine

- 2 doses at 12-15mo, booster at 4-6yo

- can get chickenpox after vaccination but should be mild

- can also prevent shingles or make milder

tx chickenpox

- skin car: oatmeal baths, calamine lotion, trim/clean nails. keep cool

- diphenhydramine (dont use lotion and oral, doubles dose)

- avoid aspirin (reyes syndrome)

- antivirual drugs: acyclovir may decreases lesions/shorten duration; w/in 48 hrs

- varicella zoster immune globulin (vzig) if high risk; w/in 96 hrs

- routine screening of pregnant moms performed to see if they have had varicella

what is shingles

- virus lies dormant in body after initial cpox infection

- later activation causes nerve pain, itching, tenderness, one sided lesions along nerve/dermatome (dont cross dermatome)

- most common in elderly but can be seen in children and ya

comp shingles

- vision problems

- skin infections

- nerve damage

- encephalitis

shingles transmission

- contact and airborne

tx shingles

- tx w antiviral meds (acyclovir and valcyclovir) and pain meds

- vaccine available for 50 + (shingrix), 2 doses, 6mo apart

getting shingles and chicken pox key features

- cant get shingles from a person w chickenpox bc have to have cpox in the past to get then

- can get chickenpox from shingles if youve never had a primary infection, transmitted by direct contact

- shingles: contagious until all lesions crusted over, keep lesions covered

what is smallpox

- worldwide eradication declared in 1980, bioterrorism concern

s/s smallpox

- starts w rash in mouth

- spots begin on face and spread outward

- all spots are at the same stage of dev, usually more on distal extremities than on trunk

comp smallpox

- severe scarring

- blindness

- 30 % mortality rate

smallpox vaccine

- not currently routinely given, post exposure immunization plan in place, provides protection if given w in 72hrs/3days

- not a shot, 2 pronged bifurcated needle dipped in soln, then skin pricked several times

- vaccines contains live vaccina virus, a similar but less harmful virus (not killed or attenuated)

rxns smallpox vaccine

- dangerous for immunocomp pts

- touching the vaccination site then touching another person or another part of the body can spread the virus

- those w eczema can have serious, widespread infection

- booster needed every 3 years for long-term protection (at risk workers)

what is polio virus

- an enterovirus (different rates of paralysis), effects spinal nerves and brain stem

- approx: 70% no s.s, 25% mild flu like s/s, <1: paralysis/death

- not eradicated, nearly eliminted

comp polio

- permanent disability or death by affecting diaphragm and resp muscles

polio transmission

- fecal/oral and resp (droplet/airborne)

polio vaccine

- inactivated polio vaccine (ipv) given in us; allows polio virus to pass through body if get it instead of spreading to nervous system, could spread to others thru feces

- oral polio vaccines (opv) not used in us since 2000 but used in other countries, live virus, kills polio virus in the body, stops outbreaks, risk for transmission

tx polio

- no cure

- pt

- tracheostomy

what is human palillomavirus (hpv)

- 40 different types

- msot sexually active persons will get hpv infection at some point in their lives

comp hpv

- most types cause no symptoms and go away on their own, but some types can cause cancers of cervix, anus, penis, vagina, and oropharynx (back of throat including base of tongue and tonsils),

- can also cause genital warts

hpv vaccine

- gardasil 9: targets hpv 16 and 19 which caues most hpv associated cancers as well as 7 other types

- rec for boys and girls 11-12yo (can be started at 9)

- 2-3 doses best to complete before sexually active but not a contraindication

- also rec for 13-26 not vaccinated prev

what is rotavirus

- was leading cause of severe diarrhea in children

- causes fever, n/v, abdominal pain, large amts of watery diarrhea and dehydration common

rotavirus vaccine

- oral drops, 2-3 doses starting at 2mo

- dont re-administer if vomits

- dont give if hx of intersusscepction (type of bowel blockage)

what are bacterial communicable disease

bacteria cause damage to host by

- bacterial reproduction (antibiotics)

- excessive immune response (antibiotics, anti-inflammatories, ivig)

- releasing toxins (poisons and endotoxins) that can directly destroy cells and tissues (antitoxin,s some antibiotics also have anti-toxin effects)

what are endotoxins

Endotoxins are primarily found in Gram-negative bacteria like E. coli, Salmonella, Pseudomonas, and Shigella.

what are exotoxins

Exotoxins can be produced by both Gram-positive and Gram-negative bacteria, with examples including Staphylococcus aureus (toxic shock syndrome), C. diff. Tetanus, Botulism.

what is conjunctivitis

- bacterial (purulent drainage) and viral (watery drainage), contagious

- can spread from eye to the other

- allergic (watery discharge)

- antibiotic drops if bacterial

what is pertussis (whooping cough)

- caused by bordetella pertussis bacteria, highly contagious

s/s pertussis

- 3 stages

- 1: cold like s/s 1-2 wks

- 2: classic whooping cough, coughing fits, 2-6wks

- 3rd: chronic cough 10 weeks or more, known as 100 day cough,

- contagious for 21 days after their cough begins or until they complete five days of antibiotics

pertussis transmission

- droplets and direct contact

pertussis vaccine

- DTaP up to 6 yrs

- Tdap: 7yo-adult, boosters now rec for teens and grandparents to prev spread to infants

pertussis tx

- antibiotics and supportive tx, possible intubation

- anyone w/ close contact of infectious child gets tx w/ antibiotics

what is diptheria

- highly contagious bacterial disease

s/s diptheria

- bulls neck (neck edema)

- thin gray membrane on tonsils and pharynx

- cough, cyanosis

comp diptheria

- resp obstruction, septic shock

- bacteria produce a toxins that damages organs