PEDS: Communicable Diseases- Chap 22

Human Papillomavirus (HPV-Gardasil)

-The human papillomavirus (HPV) vaccine prevents the most common causes of genital warts and helps prevent cervical, anal, oral, and penile cancers. -It is recommended to be given at 11 to 12 years of age (minimum age is 9 years) in a two-dose series with a minimum of 6 months between dosing. -If vaccination is not begun by age 15 years, the patient requires a three-dose series at 0, 1 to 2 months, and 6 months. -The most common side effect of immunization is syncope. o Patients should be encouraged to sit for a few minutes after the dose is given and should be warned of this side effect -HPV is contraindicated in those with a severe allergic reaction to the vaccine or its components, and caution should be used in those who are pregnant or have a moderate-to-severe acute illness

Haemophilus influenzae Type B (Hib)

-This organism was at one time a leading cause of meningitis in young children and is a significant cause of conjunctivitis, otitis media, and sinusitis. -Given in a series of four doses: at 2, 4, 6, and 12 to 15 months.

Varicella Zoster (Chickenpox)

-Varicella-zoster virus (VZV) most commonly causes chickenpox in children and rarely may cause shingles. - VZV infection most commonly presents in children with the classic rash of maculopapular lesions that begins on the head or trunk, progressing quickly to vesicles with eventual crusting and resolution. -The key finding in VZV infection is lesions in all different stages of formation and healing. The most distressing symptom for patients is often severe pruritus, which can result in scarring or secondary bacterial infections. -After an initial infection with VZV, the virus lays dormant in the nervous system, often for years. o But in some cases, during periods of the weakened immune system such as stress, the VZV will result in a secondary infection of shingles in older children and adults. Disease Process -Agent: VZV -Transmission: fluid from vesicles of an infected person; secretions from nose, mouth, and eyes; airborne from coughing and sneezing -Incubation period: 10 to 21 days -Communicability: 1 day before rash appears, while the rash is spreading, and until all vesicles have crusted over Clinical Presentation -Prodromal: fever, malaise, coryz -Rash distribution: The rash first appears on the trunk and face, then spreads to other parts of the body. The rash goes through the stages of macule, papule, vesicle, and scab (crust). All stages are present at the same time. -Severe itching may be present Systemic signs and symptoms: -fever -headache -dehydration Diagnostic Testing -Typically diagnosed by visualizing rash Nursing Interventions Emergency Care Complications may include bacterial infections of the skin, pneumonia, septicemia, encephalitis, and bleeding problems. Urgent medical care is needed for any complications. Acute Hospital Care -Children with chickenpox are not generally hospitalized unless the child is immunocompromised or experiencing complications; IV acyclovir may be given to children in these situations -Strict isolation for the hospitalized child, including contact and airborne isolation Special Considerations -It is possible to get chickenpox twice. The second case is usually mild, with less fever and few vesicles. Care is the same as for the first case of chickenpox. -A small percentage of people who receive the chickenpox vaccine get chickenpox, but the disease is mild with fewer lesions. -The risk of breakthrough is higher if the varicella vaccine is given less than 30 days after the MMR vaccine. Varicella vaccination should be given simultaneously with MMR or longer than 30 days from MMR. -It is possible to have a mild rash with a few vesicles around the injection site after varicella immunization. ------vesicles must be covered with clothing or a nonporous bandage to prevent spread to others. -------------Isolation may be needed if the rash is more widespread Caregiver Education -Use acetaminophen to relieve fever. -Aspirin or any medication that contains salicylates should never be used because of the risk for Reye syndrome. -The caregiver should receive education on the signs and symptoms of this syndrome. -Keep the child isolated until all vesicles have crusted over. -Keep the child well hydrated. -Offer cool, bland liquids because the inside of the mouth may be affected. -To help prevent itching, keep the child cool, dressed in light cotton, and distracted with play activities. -Apply gloves or mittens if necessary; keep fingernails clean and cut short. -Aveeno (oatmeal powder) or baking soda baths may bring relief. -Apply calamine or Cetaphil lotion to lesions.

Respiratory Syncytial Virus Bronchiolitis (RSV)

-Viral respiratory infection can affect all ages o Usually well tolerated with symptoms of the common cold in older children o Is the most common cause of bronchiolitis and pneumonia in infants and toddlers -In infants, toddlers, those born prematurely, and those with chronic lung or heart disease, RSV can result in a life-threatening illness. o In these individuals, significant respiratory distress, wheezing, and in some cases, respiratory failure can result from RSV. Disease Process -Agent: RSV -Transmission: contact with saliva and nasal secretions. The virus can live on surfaces for several hours and is readily transmitted by hand (s). CONTACT ISOLATION -Incubation period: This period is usually 4 to 6 days -Communicability: Viral shedding may last as long as 3 to 4 weeks in infants. In older persons, it is shed for 3 to 8 days. Clinical Presentation -Cough -Coryza (nasal congestion) -Fever -As the disease progresses in infants and young children, there may be respiratory distress with tachypnea, wheezing, retractions, severe coughing, and poor air exchange Diagnostic Testing -RSV screening Nursing Interventions Acute Hospital Care -Hospitalization may be needed for infants with bronchiolitis and pneumonia. -Contact isolation with gowns and gloves; mask if close to the infant's face -Frequent assessments of respiratory status -Schedule activities to allow rest time for infant -Cool humidified air at the bedside -Administer oxygen as needed -Hydration with IV fluids if needed Caregiver Education -Careful hand hygiene and disposal of tissues -Cool mist humidifier -Hydration -Do not administer over-the-counter cough/cold products to children younger than 4 years -Teach parents signs of respiratory distress in an infant and when to seek medical care -Immunization: infants who are at risk and more vulnerable to RSV due to medical problems may require the palivizumab (Synagis) vaccine to prevent RSV

Treating Influenza Medications for influenza must be given within 48 hours of the onset of symptoms.. There are two antiviral medications for influenza, what are they?

-oseltamivir (Tamiflu) and zanamivir (Relenza) Effective for both influenza type A and type B Oseltamivir (Tamiflu) -Given to children older than 1 year and should be given weight-based dosing. Zanamivir (Relenza) -Recommended for children older than 7 years. -It is administered as a 10-mg once-daily inhalation medication -Not recommended for children with airway disease such as asthma

Influenza

--Children aged 6 months to 18 years should receive an influenza immunization annually. --Children through 8 years of age who are receiving their first influenza immunization need two doses, at least 4 weeks apart. --Children older than 2 years have the option of receiving a live, attenuated influenza virus through a nasal spray as an alternative to the injection o If used, the nasal spray vaccine is contraindicated for children with asthma and should not be given to children aged 2 to 4 years who have been wheezing within the past 12 months. o The influenza nasal spray may cause symptoms of mild flu because it is manufactured from a weakened form of the live virus. --The influenza immunization is contraindicated for individuals who are allergic to previous doses of influenza. --Caution should be used in those allergic to eggs or egg products, or those who have moderate to severe acute illness. Hives secondary to egg allergy are not considered a contraindication

BACTERIAL COMMUNICABLE DISEASES Conjunctivitis (Pinkeye)

***Bacterial communicable diseases are highly contagious, resulting in outbreaks throughout the year, especially in schools, day-care centers, and crowded living conditions. These diseases can often be treated with antibiotics, good hygiene practices, and symptomatic care. Many of these diseases are common in the community but must be treated appropriately to prevent complications in children and adolescents -Conjunctivitis is a disease process that results in erythema and edema of the conjunctiva of the eye, as well as thick, purulent drainage in the case of bacterial infection. -Multiple bacteria can result in conjunctivitis, but the most common causes in children are respiratory and skin bacteria such as staphylococcal and streptococcal bacteria. -In neonates, sexually transmitted diseases such as herpes simplex virus, gonorrhea, or chlamydia can result in conjunctivitis, which can lead to more serious infections. -Most conjunctivitis infections resolve with appropriate treatment. -Complications such as vision loss, eye infection, and periorbital cellulitis are rare but significant. - It is important for nurses to educate families on conjunctivitis prevention and prompt treatment of eye symptoms. Disease Process -Agent: virus or bacteria -Transmission: contact with discharge from an infected eye, either direct contact or by touching contaminated surfaces -Communicability: varies depending on organism Clinical Presentation -Viral infection: pink or red conjunctiva, edema, watery discharge; may affect only one eye -Bacterial infection: pink or red conjunctiva, edema, purulent discharge, crusted eyelids in the morning, complaints of itching or pain Nursing Interventions -Teach administration of eyedrops as ordered for bacterial infections. -If conjunctivitis develops in two or more children in the same setting (home or school), the cause may be adenovirus. This may cause epidemics in school or group settings Caregiver Education -Avoid touching eyes, wash hands carefully after touching eyes, sanitize objects that have been touched by eyes or hands, discard tissues that are used to wipe eyes, and administer eye drops as ordered.

Meningococcal (Menactra or Menveo)

***Protects against meningitis -The meningococcal vaccine is given at 11 to 12 years of age with a booster at 16 years of age. -Meningococcal conjugate ACWY is given to children who are 2 to 18 years of age and are at high risk due to asplenia, immunodeficiency disorders, or HIV, or who live in or travel to a country where meningococcal disease is an epidemic -Avoid the immunization if the child was allergic to a previous dose or component of vaccine. Use caution in children who have moderate-to-severe acute illness.

Diphtheria, Tetanus, Pertussis (DTaP)

-FOUR doses are given for infants and toddlers: at 2, 4, 6, and 15 to 18 months. o A final dose in the series is given between age 4 and 6 years. -Vaccine may cause irritability, loss of appetite, and localized swelling and tenderness at the injection site. -Seizures are a rare side effect of the DTaP due to the pertussis component of the vaccine. However, this vaccine is much safer now because only acellular components are used to manufacture the vaccine. -DT is for children younger than 7 years who cannot have the pertussis component of the DTaP vaccine.

Mumps (Parotitis)

-Causes a disease resulting in inflammation primarily of the salivary glands below and in front of the ears -Inflammation can also affect other areas of the body, leading to complications such as sterility in males from orchiditis (inflammation of the testes), hearing loss, encephalitis, and pancreatitis. -Outbreaks still do occur worldwide, including a significant one in the United States in 2016. -Mumps can have systemic symptoms but most commonly present with significant parotid swelling Disease Process -Agent: paramyxovirus -Transmission: Contact with oral and nasal secretions (droplet spread) -Incubation period: 16 to 18 days -Communicability: 2 to 3 days before swelling of salivary glands to 5 days after swelling start Clinical Presentation Location: -Swelling of parotid salivary glands in front of the ear, below the ear, under the jaw -Boys may have painful swelling of the testicles (orchitis) -Girls may have ovarian involvement with abdominal pain (oophoritis) and breast inflammation (mastitis) Systemic signs and symptoms: -Headache -Fever -Earache -Muscle aches -Malaise -Loss of appetite Diagnostic Testing -IgM enzyme immunoassay is used to detect the mumps virus Nursing Interventions Emergency Care -Complications may include: -meningitis -encephalitis -glomerulonephritis -permanent deafness -sterility -myocarditis -joint inflammation. Infection during pregnancy may result in fetal death -Seek medical care immediately for complications. Acute Hospital Care -Droplet spread isolation is required. Caregiver Education -Acetaminophen or ibuprofen for fever and pain -Bland, soft foods -Bland liquids; avoid citrus juices; keep well hydrated. -Ice packs or warm compresses to the neck for comfort and pain relief -Snug-fitting underwear and warmth may provide comfort and pain relief for orchitis

Rubella (German Measles)

-Contagious viral infection resulting in no symptoms or a mild febrile illness with a rash that lasts approximately 3 days. -Rubella infection in infants and children rarely causes significant complications. -If a pregnant woman is affected, her unborn fetus can develop multiple congenital anomalies such as hearing and vision loss, heart defects, and mental retardation, referred to as congenital rubella syndrome. Given the devastating lifelong consequences to the unborn fetus, it is important that we prevent rubella through adequate immunization Disease Process -Agent: Rubella virus -Transmission: respiratory droplets or direct contact with respiratory secretions o The virus is also found in blood, urine, and stool -Incubation period: 16 to 18 days 7 days before rash until 14 days after rash; most children are contagious 3 to 4 days before rash to 7 days after rash CONTACT & DROPLET PRECAUTIONS Clinical Presentation Prodromal: -Children do not have prodromal symptoms. -Adolescents may experience mild fever, malaise, sore throat, and headache. Rash distribution: -Fine red or a pink rash that appears on the face first and then spreads downward. Systemic signs and symptoms: -Fever -Aching -Posterior cervical lymph nodes tender and swollen Caregiver Education -Home care includes fever management as needed. -Teach the importance of getting the MMR vaccine before the childbearing years.

Tetanus-Diphtheria Acellular Pertussis (Tdap)

-Due to waning immunity to pertussis, it is now recommended that all children 11 to 12 years of age receive one dose of tetanus, diphtheria, and acellular pertussis (Tdap) in place of the previous Td. -All pregnant adolescents/women should receive a dose of Tdap during each pregnancy (ideally 27 to 36 weeks gestation) regardless of time since the previous vaccine -Tdap is contraindicated in patients who have had a severe allergic reaction to the vaccine or its components, or who had encephalopathy within 7 days of the previous vaccine. -Caution should be used in those who have unstable neurological conditions, a history of Arthus-type hypersensitivity reactions after the previous dose, or moderate-to-severe acute illness

VIRAL COMMUNICABLE DISEASES Erythema infectiosum (Fifth Disease)

-Erythema infectiosum is commonly referred to as the "fifth disease" because it was historically classified as the fifth common red rash in children. o Commonly affects school-age children 5 to 15 years of age. o This rash is a self-limited viral infection but can have a persistent lacy rash for several weeks after the initial infection. Disease Process -Agent: human parvovirus B19 (HPV) -Transmission: contact with respiratory secretions -Incubation period: 4 to 21 days -Communicability: contagious until the rash appears -Precautions: droplet Clinical Presentation -Prodromal: fever, upper respiratory symptoms, headache -Rash distribution: erythema of the cheeks, giving the appearance of "slapped cheeks." The rash appears after the red cheeks appear and is characterized by a lacy pattern on the trunk and extremities. The rash may disappear and then reappear if the child becomes hot for weeks after the infection -Systemic signs and symptoms: no signs or symptoms after the rash has appeared. In adults, there may be pain and swelling of joints Diagnostic Testing -Blood testing will reveal the presence of immunoglobulin M (IgM) antibody that indicates immunity to parvovirus B19 Nursing Interventions -Nursing interventions for patients with fifth disease include emergency care and acute hospital care Emergency Care Sickle cell crisis may occur with HPV in susceptible persons. Acute Hospital Care -Fifth disease may be severe in individuals with immune deficiency disorders. -A child with HPV who is hospitalized with an aplastic crisis or because of immunodeficiency must be placed on droplet precautions. -A child in aplastic crisis may not have the typical rash, but complaint of fever, nausea, and vomiting, abdominal pain, malaise, and lethargy Caregiver Education Caregiver education should include the following topics related to Fifth disease. Emergency Care The disease may trigger a crisis in persons with sickle cell disease. It may also trigger an aplastic crisis in children who are immunodeficient. Home Care Acetaminophen or ibuprofen for fever or discomfort; adequate hydration

General History History is essential to assessment of the child who may be experiencing a communicable disease. It is important to ask about the following issues

-Exposure to the disease: Has the child been around other children who have a communicable disease? Is the child in close contact with other children at daycare or schools? Have family members been exposed to a communicable disease? -Consider the incubation period of disease and the length of time it takes for symptoms to appear from the time the child was exposed. -Has the child had any communicable diseases in the past? -What immunizations has the child had? Are immunizations up to date with the recommended schedule? -Any child 2 months or younger with a fever of 101°F or higher should be seen by a healthcare professional to evaluate for subtle signs of sepsis or other concerning infections. The very young infant does not yet have a fully functioning immune status, and presentations of communicable diseases may be subtle.

Hepatitis A

-The hepatitis A vaccine is given to all children 12 months and older. The hepatitis A vaccine is not given before 12 months of age -This vaccine is especially important in children who are traveling or who are otherwise at risk for the disease. -Two doses are given, at least 6 to 18 months apart

Hand, Foot, and Mouth Disease (HFMD)

-Hand, foot, and mouth disease (HFMD) are common among infants and children younger than 10 years. o Self-limited condition and usually resolves within 10 days without complications. o However, the child may have significant difficulty with eating and playing because of the painful lesions to the hands, feet, and mouth. o Because multiple strains cause HFMD, children can contract this virus more than once Disease Process Agent: Coxsackievirus or enterovirus Transmission: direct contact, droplet, fecal-oral Incubation period: 3 to 6 days Communicability: the virus may be shed for several weeks Clinical Presentation -Signs and symptoms: cold symptoms, coryza, fever, sore throat -Small vesicles appear in the mouth and on the palms of the hands and soles of the feet, and may also appear on the genitalia and buttocks Diagnostic Testing -Stool samples and throat swabs can be tested for the presence of a virus, but the disease is usually diagnosed clinically Caregiver Education -Careful hand hygiene and disposal of tissues -Clean surfaces and toys with soap and water, and disinfect with a solution of 1 tablespoon of bleach to 4 cups of water -Give bland foods and drinks because the mouth may be sore; make sure the child is well hydrated -Acetaminophen or ibuprofen for pain and fever -Over-the-counter sprays and mouthwashes that contain a local anesthetic to relieve pain in the mouth

Hepatitis A (HAV)

-Hepatitis A virus (HAV) is a disease process that causes inflammation and decreased liver function. -The most common source of HAV is contaminated food or water. -Most patients have a mild illness and recover without permanent liver damage within 2 weeks. Disease Process -Agent: HAV viral infection -Transmission: fecal-oral route, contaminated food -Incubation period: approximately 30 days -Communicability: most contagious for 2 weeks before the onset of symptoms and for 1 week after onset of jaundice Clinical Presentation -Fever, malaise, poor appetite, nausea, jaundice, abdominal pain, dark urine -Children younger than 6 years may have mild or no symptoms; therefore, they may play a significant role in the transmission of HAV Diagnostic Testing -Blood test for the presence of anti-HAV IgM in the serum -Other abnormal laboratory work: the presence of bilirubin in urine, elevated serum bilirubin, elevated liver enzymes (aspartate transaminase and alanine transaminase) Nursing Interventions -Contact isolation if the child is incontinent with feces -Immune globulin can be given after exposure to prevent or reduce the severity of the disease -Report incidence to the local health department Caregiver Education -Strict hand hygiene and sanitizing of surfaces -Appropriate rest and activity -Nutritious, well-balanced diet

Hepatitis B

-Hepatitis B virus (HBV) is a virus that can cause short-term and long-term liver dysfunction. -HBV is commonly transmitted through blood or body fluids. -Some children younger than 5 years will show no symptoms of HBV; however, 50% of individuals older than 5 will experience signs and symptoms of liver dysfunction and inflammation including jaundice, vomiting, and abdominal pain. -The disease process can last from weeks to months; at longer than 6 months, HBV is considered chronic and puts the individual at long-term risk for cirrhosis and liver cancer Disease Process -Agent: HBV viral infection -Transmission: blood or blood products, sexual contact -Incubation period: average of 90 days -Communicability: can be spread as long as the virus is in the blood of an individual; some people are chronic carriers and carry the disease for life Clinical Presentation -Symptoms include aching, malaise, joint pain, jaundice, dark urine, loss of appetite, and mild right upper quadrant abdominal pain. -Children with chronic hepatitis B may be asymptomatic. -Children with chronic hepatitis B are at risk for the development of hepatocellular carcinoma later in life. -Newborns may acquire HBV perinatally. -High-risk groups among children and adolescents include those living in institutions, those involved in IV drug use, those infected by sexual partners, and children who are hemophiliacs or receive frequent blood transfusions. Individuals who have traveled to Africa or Asia are also at higher risk Diagnostic Testing -Blood tests reveal the HBsAg and the IgM anti-HBc core antibody. -In chronic hepatitis B, the positive HBsAg persists. -Chronic carriers are those who have a positive HBsAg for more than 6 months. HBV DNA markers will also be present. Nursing Interventions -Blood-borne precautions (universal precautions) Caregiver Education -Teach family members not to share toothbrushes or razors. -Lifestyle counseling is necessary if risky behaviors such as drug use or sexual activity are present. -Teach the importance of treatment and follow-up

Inactivated Poliovirus (IPV)

-Inactivated poliovirus vaccine (IPV) has replaced the live, oral vaccine (OPV) in the United States. -IPV is safer to use because OPV contains live viruses and may cause paralysis in immunodeficient children or in close contacts who are immunodeficient. -IPV is given in a series of four doses: at 2, 4, and 6 to 18 months, and 4 to 6 years.

Signs of Dehydration ` Teach parents the signs of dehydration for seeking medical care:

-Lethargy -No tears when crying if older than 2 months -For young infant, less than five or six wet diapers in 24 hours -Eyes sunken -Skin not elastic (poor skin turgor) -Fontanel sunken

Meningococcal Serogroup B Vaccine (MenB-FHbp or MenB-4C)

-Meningococcal serogroup B vaccine is recommended for individuals at age 10 and at age 25 years who are at risk for meningitis serogroup B. -Increased risks include persistent complement component deficiencies, those with functional or anatomic asplenia, or routine exposure to these diseases. -The vaccine can also be given to healthy individuals 16 to 23 years of age for short-term protection against the most common strains of meningococcal disease. -Persons who are at high risk should receive the vaccine in a three-dose series with vaccine spacing of 1 to 2 months following initial vaccine for second vaccine and 6 months for the third dose of the vaccine. -Persons who are healthy should receive the vaccine in a two-dose series with 6 months spacing between initial and second dose of vaccine. -It is contraindicated in pregnant/lactating women or in those who have had a severe allergic reaction to the vaccine or any part of the vaccine including latex

Administering Eyedrops

-Perform hand hygiene. -Draw the correct amount of medication into the dropper. -Do not touch the dropper to the eye or any other surface. The dropper must remain sterile. -Tilt the child's head back and pull down the lower eyelid. The child can be instructed to look up at the ceiling. -Squeeze the correct number of medication drops into the pouch formed by pulling down the lower eyelid. -Allow the child to close the eye. Gently press the tear duct situated in the inner corner of the eye. -Gently wipe off excess solution with a clean cotton ball or gauze pad. -Perform hand hygiene.

Hepatitis B

-The hepatitis B vaccine is administered to all newborns. o Three doses of hepatitis B are given before age 2 years: at birth, at 1 to 2 months of age, and at 9 to 12 months of age -If the mother is positive for hepatitis B surface antigen (HBsAg), 0.5 mL of hepatitis B immune globulin (HBIG) is also given. -If a dose is missed, the series does not have to be restarted. It should be continued. -A specific contraindication to hepatitis B is a hypersensitivity to yeast

Pertussis (Whooping Cough)

-Pertussis is also known as whooping cough because it causes a characteristic "whoop" sound after paroxysmal coughing fits. -This disease mainly affects babies or children who are not immunized or not fully immunized. -Pertussis begins with similar symptoms to a common upper respiratory infection, followed by an increase in symptoms that include the classic paroxysmal coughing fits with posttussive inspiratory whoop and vomiting. Disease Process -Agent: Bordetella pertussis -Transmission: oral and nasal secretions -Incubation period: 6 to 21 days -Communicability: contagious from the onset of symptoms and for about 2 weeks; infants who have not been immunized may be contagious for at least 6 weeks The disease is most dangerous to young infants Clinical Presentation Catarrhal phase that lasts 1 to 2 weeks: cold symptoms, including coryza, mild cough, and fever Paroxysmal phase that lasts 1 to 6 weeks or longer: cough ends with crowing (whooping) and may be severe enough to cause vomiting and cyanosis; the classic whoop may not occur in an infant; respiratory distress may be severe Recovery phase -the cough gradually becomes less severe ***In some children, adolescents, and adults, pertussis may present as a chronic cough that lasts for weeks; the crowing or whooping may not always be present Diagnostic Testing The polymerase chain reaction test identifies the genetic material of the B. pertussis bacteria in nasal secretions. Nursing Interventions Infants have more severe cases of pertussis and may require hospitalization to manage respiratory distress and dehydration. Caregiver Education -Give small a`mounts of fluid frequently to keep the child hydrated, especially during bouts of vomiting. -Refeed or give small amounts of fluid after episodes of coughing and vomiting. -Teach signs of respiratory distress and dehydration, and urge parents to seek medical care as needed. -Provide for rest and quiet activities, and avoid stimuli that trigger coughing. -Use a cool-mist humidifier ****Pertussis must be treated with azithromycin (Zithromax), erythromycin, or clarithromycin. Treatment should be started before 21 days into the illness

Pneumococcal (PCV13 and PPSV23)

-Recommended for children younger than 5 years to protect against Streptococcus pneumoniae (pneumococcus). -Four doses of PCV13 are given in the series: at 2, 4, 6, and 12 to 15 months. -Used for older children and adults, but may be used in children older than 2 years who have special medical conditions such as a cochlear implant or are asplenic from sickle cell anemia. -It can cause ear infections, and it can also lead to more serious infections of the: o Lungs (pneumonia) o Blood (bacteremia) o Covering of the brain and spinal cord (meningitis).

Signs of Respiratory Distress Teach parents the signs of respiratory distress for seeking medical care:

-Restlessness, anxiety -Respiratory rate over 60 in an infant, over 40 in a toddler -Retractions -Wheezing -Distress that increases when lying down -Breathlessness, gasping, continuous coughing -Nasal flaring -Color changes—duskiness around mouth, pallor -Crowing sound when taking a breath -Hoarse cry or barking cough

Reye Syndrome

-Reye syndrome is a life-threatening disease that primarily affects the brain and liver o It typically follows a viral infection such as chickenpox, influenza, or an upper respiratory infection. -The ingestion of aspirin or other medication that contains salicylates during a viral illness greatly increases the probability of the development of Reye syndrome -It is important to teach caregivers not to give aspirin or salicylate products to any child or adolescent during a febrile illness

Rubeola (Measles)

-Rubeola is a viral syndrome resulting in a rash for 7 days, often referred to as measles. -The disease process is usually a self-limiting moderate illness in most children, presenting with rash and fever. Complications -Encephalitis -Pneumonia -Death can occur in children younger than 5 years and adults. o Prior to immunizations, many children and adults died of complications related to rubeola. -Rubeola is still present worldwide and has intermittent outbreaks, most recently in multiple states in the United States in 2017. It is essential to prevent this disease through adequate immunizations to avoid the complications associated with rubeola Disease Process -Agent: measles virus -Transmission: airborne through respiratory droplets or direct contact with respiratory secretions -Incubation period: 8 to 12 days -Communicability: 1 or 2 days before prodromal symptoms, 3 to 5 days before the rash, 4 days after the rash appears AIRBORNE PRECAUTIONS Clinical Presentation Prodromal: -coryza -cough -conjunctivitis -fever -malaise -small red spots in the mouth with a bluish-white center Rash distribution: -The brownish-red macular rash starts at the hairline and spreads downward over the body Systemic signs and symptoms: -Fever -Cough -Red, watery eyes -Coryza Diagnostic Testing -Blood test to detect antibodies Nursing Interventions Emergency Care -Complications include ear infections, diarrhea, encephalitis, pneumonia, seizures, deafness, mental retardation, and death. **Seek medical care immediately for complications!! Acute Hospital Care -Airborne isolation is required. Chronic Home Care -Long-term care, including ventilator care, may be needed for children with brain damage resulting from measles encephalitis Caregiver Education -Manage fever with acetaminophen or ibuprofen. -Keep the child isolated for 5 days after the rash appears. -Dim lights if photophobia exists. -Use warm compresses to remove crusting from eyes as needed. -Give soft, bland foods. -Keep the child well hydrated with plenty of fluids. -Use a cool mist humidifier.

Shingles (Herpes Zoster)

-Shingles (herpes zoster) occurs when the VZV that causes chickenpox becomes reactivated in the nervous system, causing a painful, blistering rash in the portion of skin supplied by a particular nerve fiber (dermatome) -The person has already completely recovered from chickenpox and the virus that was inactive (latent) becomes active, often years after having chickenpox. -Educate caregivers that a child cannot get shingles from someone with chickenpox. -However, a child may contract chickenpox from an individual with shingles if there is direct contact with uncovered lesions. -Shingles lesions must be covered to prevent spread. It is contagious until all lesions are crusted over

Immunizations Nurses should be aware of the following considerations when it comes to administering immunizations.

-Some immunizations may cause mild fever or soreness and redness at the injection site. Teach parents how to calculate appropriate doses of acetaminophen to relieve pain or fever after the immunization. -Discuss with parents that acetaminophen (Tylenol) or ibuprofen is not needed unless the child is uncomfortable with the fever or pain. These medications are no longer recommended because of the potential to decrease immune reaction to the vaccine -Children with mild cold symptoms may receive immunizations. However, if they are moderate to severely ill with or without fever, it is better to hold the immunization until later -Legal caregivers must receive a vaccine information statement (VIS) that explains the purpose of the vaccine, possible side effects, and how to care for the child. o This statement also informs and questions the caregiver about possible contraindications and allergies to the vaccine. o Caregivers must sign a permission form before the child receives the immunization. o VIS forms can be obtained in many languages. -All adverse effects of immunizations must be reported. The physician or nurse practitioner may file a Vaccine Adverse Event Report with the Centers for Disease Control and Prevention -Documentation must include the lot number of the vaccine. The lot number is recorded on the vaccine label. Documentation also includes the route and site of vaccine administration and the date that the vaccine was given. o Copies of permission forms must be kept on file, as well as the manufacturer and source of the vaccine and the date of the VIS form.

Mononucleosis

-Sometimes called mono or the "kissing disease" because it is commonly transmitted through saliva -Epstein-Barr virus (EBV) is most common among adolescent patients but can affect individuals of all ages. o Results in an increase in white blood cells with a single nucleus, called monocytes or mononuclear lymphocytes. o Most patients have a self-limited disease that lasts a few weeks, but rare cases will lead to long-term chronic fatigue syndrome Disease Process -Agent: EBV -Transmission: person-to-person contact, sharing personal objects such as cups or toothbrushes, through saliva -Incubation period: 30 to 50 days -Communicability: virus may be excreted for months after infection Clinical Presentation -Fever -Sore throat -Malaise -Pharyngitis -Enlarged posterior cervical lymph nodes, with symptoms lasting 1 to 4 weeks -May develop splenomegaly or hepatomegaly -Disease primarily affects adolescents and young adults; children often have very mild symptoms, and adults are usually immune due to previous exposure Diagnostic Testing -Positive mono spot test -Positive Paul-Bunnell heterophile antibody test -Increased lymphocytes (WBC) -Greater than 10% atypical lymphocytes -EBV antibody titers Nursing Interventions -Hospitalization may be needed if the child experiences respiratory distress, abdominal pain with splenomegaly, or dehydration due to inability to swallow adequate fluids Caregiver Education -To prevent injury to the spleen, no contact sports for 6 to 8 weeks if the spleen is enlarged. Examples of contact sports include basketball, football, soccer, rugby, baseball, boxing, ice hockey, rodeo, wrestling, martial arts, lacrosse, and water polo -Rest, with appropriate quiet activities and play -Fever management with acetaminophen or ibuprofen -Hydration and nutrition -Counseling and emotional support for adolescents who must be on bed rest

Influenza

.-Contagious disease process that occurs worldwide annually and is often epidemic. o The influenza virus constantly mutates, resulting in new strains annually. o The most common months for influenza in the United States are October through May. o Most patients have a self-limited disease with common symptoms o Infants, very young children, those with chronic diseases, and older adults are at increased risk for complications related to the flu Disease Process -Agent: influenza viruses; influenza may type A or type B, with type A being much more prevalent -Transmission: coughing and sneezing; contact with objects contaminated with oral or nasal secretions -Incubation period: 1 to 4 days -Communicability: 1 day before symptoms until approximately 7 days after the child becomes ill Clinical Presentation -Fever -Chills -Headache -Sneezing -Cough -Malaise -Conjunctivitis -Myalgia (aching) Diagnostic Testing -Rapid screening for flu virus antigens in nasal secretions Nursing Interventions Emergency Care -Influenza may trigger croup in infants. Acute Hospital Care -Pneumonia is a complication of influenza and may require hospitalization. -Other complications include ear infections, sinus infections, dehydration, myocarditis, pericarditis, and increased severity of existing medical conditions such as diabetes and asthma. -Droplet isolation is necessary Caregiver Education -Tylenol or ibuprofen for fever (no aspirin because of risk for Reye syndrome) -Careful hand washing and disposal of tissues -Encourage fluids =Administration of medications within 48 hours of symptoms -Importance of annual influenza immunizations Complementary and Alternative Therapies Multiple herbs, minerals, vitamins, and other treatments may be effective in reducing replication, reducing inflammation, and decreasing length of symptoms for those affected by influenza and other upper respiratory infections

Physical Examination 1. Physical assessment of a child with communicable disease includes assessing prodromal signs and symptoms that may appear before a rash or the main illness appears. The prodromal period is often associated with increased communicability of the disease. Prodromal signs and symptoms may include: 2. General signs and symptoms experienced by a child with communicable disease include:

1. -Coryza (runny nose) -Cough -Fever -Malaise 2. -Changes in behavior—lethargy or irritability -Skin rashes that may itch and may include macules, papules, pustules, and vesicles -Enlarged lymph nodes that may vary in location based on the disease but are predominately located in the anterior cervical, posterior cervical, and tonsillar areas -Fever -Vomiting and diarrhea -Pain in any part of the body, including headache, abdominal pain, throat pain, or muscle aches

Types of Immunity

Active immunity is when a person is exposed to the disease organism and makes his or her own antibodies. Active immunity is permanent or long-lasting. o Natural active immunity: a person actually has the infection and is then immune to the disease o Vaccine-induced immunity: active immunity to a disease that comes from being immunized with a killed or weakened form of that disease Passive immunity is when a person is given antibodies to a disease. This immunity is temporary and lasts for only a few weeks or months. o Natural passive immunity: antibodies are passed from mother to fetus by way of the placenta o Passive immunity: given through immune globulins to provide immediate protection against a disease

Ibuprofen Administration Ibuprofen should never be given to infants younger than

Ibuprofen should never be given to infants younger than 6 months secondary to immature renal function that takes 6 to 12 months to reach adult activity. Use of ibuprofen can cause reduction of kidney function

Types of Vaccines

Inactivated or killed organism (example: inactivated poliovirus): The virus is disabled and unable to replicate itself, but it still contains enough of the original characteristics that it can stimulate an immune response. Live attenuated or weakened virus (examples: MMR and the varicella vaccine, RV) Acellular vaccine (examples: pertussis and Hib): The vaccine contains fragments of cells that stimulate an immune response but does not contain the whole cell . Toxoids (examples: tetanus and diphtheria): Toxins produced by the bacteria are inactivated so that they cannot cause harm but can still stimulate an immune response. Subunit of virus (example: hepatitis B): Small fragments of viral protein are used

Reducing Fear of Immunizations by Developmental Stage Based on the child's developmental stage, different comfort measures are more effective:

Infant comfort measures: swaddling, being held by parents with legs exposed, pacifier, feeding, the use of sugary substances to suck on, and distracting objects in older infants Toddler comfort measures: simple explanations of what to expect, comfort holds by parents or assistant, distraction measures, managing parental anxiety, positive instructions, and positive rewards School-age comfort measures: more complex preparatory discussions; use of distractions like deep breathing, guided imagery, interactive toys, coaching activities such as counting to the end of the procedure, and talking about other things like pets

Treatment for Hepatitis B Virus Two medications may be used for children with chronic HBV

Interferon-alpha reduces replication of the HBV virus. It may be given as a subcutaneous injection at 6 months. Side effects include fever, aching, joint pain, anorexia, and weight loss. Lamivudine inhibits replication of the HBV virus. This drug is given orally, and treatment may last for 1 year. There are fewer side effects than with interferon, but lamivudine may develop resistance

Routes of Vaccines

Intramuscular vaccines Diphtheria, tetanus, pertussis (DTaP, DT, Tdap, Td) Hib Hepatitis A Hepatitis B HPV Influenza, trivalent inactivated Meningococcal—conjugate PCV Intramuscular or subcutaneous PPSV IPV Subcutaneous MMR Varicella Meningococcal—polysaccharide Oral Rotavirus

Measles, Mumps, Rubella***

Measles, mumps, rubella (MMR) is a live attenuated virus vaccine -The minimum age for receiving this immunization is 12 months. o Do not give before the first birthday unless traveling outside the United States, in which case the child will need to still receive two doses of vaccine per regular schedule. o The second dose is generally given at 4 to 6 years of age but may be given before age 4 years if at least 4 weeks have elapsed since the first dose. -Children may experience maculopapular rash, fever, swollen cheeks, and mild joint pain -MMR is contraindicated for persons who are allergic to vaccine components, are pregnant, have immunodeficiency, or have a family history of altered immunocompetence. -Caution should be used if the patient is a recent recipient of antibody-containing blood products, intravenous gamma globulin, has a history of thrombocytopenia, has the need for tuberculosis (TB) skin test or IGRA (interferon-gamma release assay) testing, and those with moderate-to-severe acute illness. o The TB test may be given before or at the same time as the MMR vaccine or 28 days later. -The MMR vaccine may be given to a child who is HIV positive as long as he or she is not severely immunocompromised

Roseola (Exanthem Subitum, Human Herpes Virus 6)

Roseola is defined as a rose-colored rash and is also called roseola infantum because it is most common among infants and toddlers. Many patients are asymptomatic when they have the virus, but classic presentation of this disease is a high fever that resolves after about 3 to 7 days, after which the rose-colored rash emerges throughout the body. The disease process is usually benign and self-limited, but rarely causes febrile seizures in infants with very high fevers. Disease Process -Agent: human herpes virus 6 -Transmission: saliva of persons who have the disease or are carrying the virus; 75% of adults carry the virus in their saliva without symptoms; most people have had roseola by age 4 years -Incubation period: 9 or 10 days -Communicability: unknown Clinical Presentation -Prodromal: high (potentially as high as 103°F or greater) for 3 to 7 days; the high fever may trigger febrile seizures -Rash distribution: papular pink or red rash that appears on the day that the fever returns to normal Diagnostic Testing Typically diagnosed based on the rash. A blood test may look for antibodies. Nursing Interventions Emergency care may be needed for febrile seizures. Caregiver Education Home care includes fever management, sponging with tepid water, and administration of acetaminophen or ibuprofen

Rotavirus

Rotavirus is a live attenuated vaccine --Rotavirus causes severe diarrhea and dehydration. --The first immunization is given between 6 and 14 weeks. --Three doses of RotaTeq vaccination are given orally at 2, 4, and 6 months. --Avoid immunization if the child has a history of intussusception, other gastrointestinal disorder, or severe combined immunodeficiency.

Strep Throat/Scarlet Fever

Strep throat. -The disease affects all ages but is more common in children older than 2 years, especially school-age children. -Abrupt onset of symptoms - In some children, the symptoms of strep are subtle, so a good history and physical examination are essential for these children. -Prevention and treatment are essential to prevent complications such as rheumatic fever. Disease Process -Agent: group A beta-hemolytic streptococcus; causes Group A Streptococcus (GAS) pharyngitis and may also cause impetigo -Transmission: droplet spread, direct contact with secretions -Incubation period: 2 to 5 days -Communicability: approximately 10 days without treatment; no longer contagious after 24 hours on antibiotics Clinical Presentation Presentation includes: -Sore throat -Fever -Headache -Enlarged and tender anterior cervical and tonsillar lymph nodes, -Abdominal pain -Decreased appetite Cough and coryza are not major signs of strep throat. ***If a child has nasal congestion, the sore throat is likely caused by another organism. -Children younger than 3 years may have a streptococcal infection without complaining of a sore throat. Symptoms may include fever, irritability, and nasal discharge. -Scarlet fever is strep throat with a fine, red rash that has the texture of sandpaper. o The rash is more pronounced in the armpits and groin, in the creases of the elbows, and behind the knees. o After the rash fades, the skin of the fingers and toes may peel. o There may be pallor around the mouth and a white tongue with swollen, red papillae (strawberry tongue) Diagnostic Testing -Rapid strep test, throat culture Nursing Interventions -Complications of untreated strep throat include glomerulonephritis and rheumatic fever Caregiver Education -Administration of penicillin or amoxicillin as ordered -Fluids to keep the child hydrated—soups, popsicles, milkshakes -Cool mist humidifier -Acetaminophen or ibuprofen for pain and fever -Replace toothbrush -Throat lozenges Complementary and Alternative Therapies -Saltwater gargles

Varicella (Varivax)***

Varicella is a live attenuated virus vaccine. -The minimum age for receiving this immunization is 12 months. Do not give before the first birthday. -The second dose is generally given at 4 to 6 years of age but may be given before age 4 years if at least 3 months have elapsed since the first dose. -Negative side effects include erythema and soreness at the injection site. A few people may experience a varicella-type rash at the injection site. -Varicella vaccine is contraindicated for persons who are allergic to components of vaccines or have had a previous severe allergic reaction to the vaccines, those with severe immunodeficiency, those who are pregnant, or those with a family history of altered immunocompetence. o Caution should be used in those with recent antibody-containing blood products or with moderate-to-severe acute illness. -The vaccine should not be given if antiviral drugs have been given in the previous 24 hours, and antiviral drugs should be avoided 14 days after the varicella immunization -If a child is taking aspirin for another condition such as Kawasaki disease, then the parents/caregivers should be educated about the signs and symptoms of Reye syndrome