Chapter 32

The Child with a Communicable The Child with a Communicable DiseaseDisease

Communicable DiseaseCommunicable Disease

• Prevention and control are the key factors in managing infectious disease

• HIV, hepatitis, TB, and STIs are infections continue to occur worldwide

• The incidence of common childhood communicable disease has decreased with the use of appropriate immunizations

• The nurse must know and be alert to signs and symptoms of communicable disease because air travel enables rapid transmission around the world

2

Review of TermsReview of Terms

• Communicable disease—can be transmitted from one person to another

• Incubation period—time between exposure to pathogen and onset of clinical symptoms

• Prodromal period—time between earliest symptom and appearance of typical rash or fever

• Vector—an insect or animal that carries and spreads disease

3

Review of Terms (cont.)

• Pandemic—a worldwide high incidence of a communicable disease; i.e., H1N1 influenza

• Epidemic—sudden increase of disease in localized area

• Endemic—an expected continuous incidence of disease in a localized area

• Opportunistic infection—caused by organism normally present in the environment that the immune-suppressed person cannot fight

• Health care–associated infection—an infection acquired after admission to a health care facility

4

Virulence of Infection

• Host resistance to disease is influenced by– Age– Sex– Genetic makeup– Nutritional status– Physical/emotional health– Phagocytes in blood to attack/destroy pathogens– Intact skin and mucous membranes– Functioning immune system

5

Worldwide Immunization Programs

• Healthy People 2020– The USPHS goal for 2020 is to have 95% of

all children in the U.S. immunized against childhood communicable diseases

• Increase education• Accessibility to health clinics• Reduce the cost of immunizations• Follow-up and track immunizations• CDC provides advice concerning vaccinations

needed when traveling (www.cdc.gov)

6

VaccinesVaccines

• Multiple doses at predetermined intervals may be needed to achieve an immunity

• Used to prevent disease, cannot be used to treat disease

• Route of administration– Important to achieve immunization

• Proper storage and handling will ensure potency– Do not store in refrigerator door– Store in center of shelves, away from vents– Store at 35-46° F (1.6° to 7.7° C)

7

Nursing TipNursing Tip

• The earliest age a vaccine should be administered is the youngest age at which the infant’s body can respond by developing antibodies to that illness

8

Allergies and ToxicitiesAllergies and Toxicities

• Epinephrine should be available in unit where immunizations are given

• Child should be observed for 20 minutes after immunization

• Do not administer the following vaccines if patient is allergic to– Baker’s yeast: avoid recombinant hepatitis B

vaccine– Eggs: avoid influenza vaccine, MMR– Neomycin: avoid IPV, MMR, and varicella

vaccine

9

Allergies and Toxicities (cont.)

• Varicella must be given same day as MMR or no less than one month later

• A tuberculin skin test should not be given within 6 weeks of MMR or varicella

• Thimerosal: a mercury-containing preservative in some vaccines can cause toxicity

• Some vaccines can be given on the same day but must be in different syringes and administered in different sites

• Serious adverse events must be reported to the national VAERS

10

Contraindications to Immunizations

• Immunocompromised state• Pregnancy (with certain vaccines)• Bacteremia or meningitis• Immunocompromised caregiver in the home

– Requires individual evaluation by the health care provider

• Corticosteroid therapy – Requires individual evaluation

• History of high fever or other reaction after previous immunization

11

Nursing TipNursing Tip

• An interrupted vaccination series can usually continue without restarting the entire series

12

The Future of Immunotherapy

• Refining and combining vaccines continues

• Transcutaneous immunization through intact skin

• Recombinant DNA technology is developing vaccines for use with rheumatic fever and malaria

• Development of RNA and DNA viruses to be used as vectors (carriers) of antigens

13

The Future of Immunotherapy The Future of Immunotherapy (cont.)(cont.)

• Development of “gene gun” to blast vaccine through intact skin

• Development of immunotherapy for non-communicable diseases such as mucosal administration of myelin for multiple sclerosis

• Development of tumor antigens

14

Bioterrorism and the Pediatric Bioterrorism and the Pediatric PatientPatient

• Children are more vulnerable as immune system is not fully developed

• Children are closer to the ground so heavy particles from aerosol-propelled agent reaches them in higher doses than adults

• Safety of new drugs developed may not yet be available for children

15

Bioterrorism and the Pediatric Patient (cont.)

• Routine “HazMat” decontamination procedure may not be suitable for pediatric patient who is prone to hypothermia (due to large head and body surface area; low fat content of body)

• A small blood volume makes child more susceptible to fluid losses from GI toxins

• Gas masks may not be available in children’s sizes

• TV coverage of terrorist attacks can affect child’s feeling of safety in the home and can alter behavior

16

Emergency PreparednessEmergency Preparedness

• Family should keep several days supply of food, water, pet food, warm clothing, blankets, medicines, copies of vital documents and toiletries

• Battery-powered radio, basic first aid supplies• Hold disaster drills in the home• Have out of state family contact numbers to call

in case the family is separated• Children should be taught to keep personal ID

with them and how to call for help when needed

17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Initial Observations During Initial Observations During DisastersDisasters

• Assess the “ABCs” and mental status• Heightened awareness by health care

personnel plays critical role in facilitating early recognition of bioterror attack

• Work with emergency department, Infection Control staff, and the local public health department to help coordinate actions that are needed

• NOTE: It is imperative to follow your chain of reporting at your facility

18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

The Pediatric Patient in a Disaster Setting

• Has a proportionately larger body surface area, thinner skin

• May have increased pulmonary problems compared to the adult

• Children are closer to the ground and may be exposed to more toxins

• Immature blood-brain barrier and increased CNS receptor sensitivity increases their sensitivity to nerve agents

• Use of Broselow-Luten color-coded, water-resistant tapes for drug calculations decreases risk of medication errors

• Can also use the Pediatric Antidotes for Chemical Warfare for dosage calculations

19Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.