INFECTIOUS DISEASES - PEDS CHAPTER 15

Communicable Disease - is a disease caused by an infectious agent that is

transmitted to a person by direct or indirect contact, vehicle or vector, or
airborne route.
Children experience higher incidences of infectious diseases than adults
because of an immature immune system developmental and biological
variances.
Infectious diseases are caused by pathogens (disease producing
microorganisms) that invade the body.
The transmission of disease is dependent upon SIX FACTORS:
1. Infectious Agent: the specific pathogen must be present in
sufficient numbers to cause disease. Some organisms have a
greater virulence (the degree or power of microorganisms to cause
disease) than others and can be more devastating, depending on
the age of the child and the development of the immune system.
2. Reservoir: A place where pathogens can survive without
multiplication. Reservoirs can be animate (living), such as humans'
animals, and insects, or inanimate (not living), such as soil, water,
other environmental sources, and medical equipment (intravenous
[IV] solutions and urine collection devices).
3. Portal of Exit from Reservoir: Pathogens can leave the reservoir
through the blood or body secretions such as urine, feces,
respiratory secretions, and saliva.
4. Mode of Transmission: Pathogenic organisms are spread by
direct contact from person to person through saliva, droplets from
the respiratory tract, body contact, blood, and body fluids in the
urinary, gastrointestinal, and reproductive systems. Pathogens can
also be transmitted on objects, in contaminated water or food, or by
vectors (animals or insects that carry the infectious organism from
one host to another like a chicken from China transmitting Bird Flu)
5. Portal of Entry to the Host: Pathogens can enter the body
through the respiratory tract, the skin and mucous membranes, and
across the placenta.
6. Susceptible Host: Pathogens cause illness when the individual
lacks immunity to specific organisms or when the immune system is
dysfunctional.

INFECTIOUS DISEASES - PEDS CHAPTER 15

Other factors that support the development of disease include:

1.) The ability of the pathogens to survive in the environment,
2.) The asymptomatic or carrier state; and
3.) The dose of the pathogen.
1. Many organisms remain viable from hours up to several weeks on
environmental surfaces such as toys or changing tables in a day care center.
Children put fingers and toys in their mouths during playtime, thus increasing
the possibility of infection if the environment is not cleaned properly.
Examples include hepatitis A, rotavirus, and Giardia cysts.
2.) - Many children may remain asymptomatic but are able to transmit
pathogens before they become ill. For example, children exposed to the
varicella virus, which causes chickenpox, are contagious the day prior to
becoming ill but may exhibit none of the characteristic lesions at that time.
Others may be carriers (persons who can harbor and spread the organism to
others without becoming ill, think of Typhoid Mary, lol.)
3.) - The Dose of the pathogen/concentration of pathogens in a particular
sample of fluid or blood determines whether or not infection occurs after a
single exposure.
Family Teaching PG. 472
The Spread of Infection
Home
Instruct caregivers on how

Day Care Or School

Instruct personnel in

Community
Educate community groups

INFECTIOUS DISEASES - PEDS CHAPTER 15

infection spreads

Emphasize careful hand

washing before and after
eating, bathroom, prior to
and after having bodily
contact with another,
after coughing and
sneezing.
Discuss the importance of
cleanliness and sanitation
especially if their children
attend institutional
settings such as day care
or preschool.
Have caregivers explore
the sanitary practices of
day care and school staff.

these settings to wipe

surface areas used for
diaper changing with a
disinfectant after each
use.
Wear gloves for diaper
changes as indicated in
day care or school policy
manuals.

Avoid changing diapers

on rugs, upholstered
furniture, and bed
coverings.
Supervise children in
hand washing before
and after eating, after
using the bathroom,
prior to and after having
bodily contact with
another, and after
coughing or sneezing.

about methods to decrease

the spread of infection.

Act in a consultant role to

groups in the community
and offer education about
the spread of illness to the
following: church groups,
senior citizens groups,
parent-teacher groups, and
youth groups.
Discuss the importance of
keeping immunizations up to
date for children as well as
adults and senior citizens.
Promote yearly
immunizations against
influenza for groups that are
susceptible to being
exposed.

INFANCY - the process of transmitting a disease from one generation to another is

known as VERTICAL TRANSMISSION. It can occur through the placenta while the
infant is in utero, during delivery, or through breast milk following delivery. Among
the infections transmitted in this way are rubella, herpes, hepatitis B and C, and
human immunodeficiency virus (HIV). Newborns are susceptible to invasive
infection by bacterial organisms such as staphylococci or Escherichia coli, which in
older children or adults are considered part of the normal flora.
TODDLERS AND PRESCHOOLERS - toddlerhood is a period of exploration and
further development.
Most toddlers become toilet trained during this phase.
May not always be diligent about washing their hands, so they are still at risk
for developing diseases transmitted through the FECAL-ORAL ROUTE.
Day care and encounters with other toddlers in diapers add to the risk.
Toddlers and some preschoolers still put objects in their mouths. It may be
difficult to break the cycle of infection if sanitary conditions in these
situations are lax.
Some toddlers and preschoolers enjoy encounters with small animals such as
dogs or cats; which places them at risk for being scratched or bitten.

INFECTIOUS DISEASES - PEDS CHAPTER 15

Organisms present in animal saliva or on their bodies can cause illness in any
child who is scratched or bitten.
Playing with infected animals may cause tinea corporis (ringworm of the
body, or cat scratch fever).
SCHOOL-AGE CHILDREN
Same sex friendships are common in school-aged children
Mutual sharing of items of clothing, grooming devices, food, and toys.
Children may spend the night together at each other's homes or on camping
trips.
Sharing beds and linens as well as personal items such as combs can result in
outbreaks of head lice, scabies, pinworms, tinea corporis and tinea capitis.
The leading cause of pneumonia in this age group is MYCOPLASMA
PNEUMONIAE (found where children are usually grouped together and is
highly contagious) can result in illness ranging from inflammation of the
trachea and bronchioles to pneumonia.
Behaviors exhibited among some schoolchildren such as not covering one's
mouth while coughing or sneezing and not washing hands afterwards are
contributing factors.
FIFTH'S DISEASE has a characteristic lacy rash and is highly contagious.
The illness is caused by parvovirus B19. By the time the rash erupts, children
are no longer contagious. Fifth disease is a mild rash illness caused by
parvovirus B19. This disease, also called ERYTHEMA INFECTIOSUM, got
its name because it was fifth in a list of historical classifications of common
skin rash illnesses in children. It is more common in children than adults. A
person usually gets sick with fifth disease within 4 to 14 days after getting
infected with parvovirus B19.

Fifth's Disease aka Parvovirus B19 aka

Erythema Infectiosum
Avoid using aspirin to treat fever of viral illnesses such as influenza and
varicella in children less than 13 years old.
o Use of acetylsalicylic acid has been linked to the subsequent
development of Reyes syndrome, a disorder combining both
encephalopathy and fatty degeneration of the liver.
o Acetaminophen or ibuprofen, are the drugs of choice for febrile
illness in infants and children.

INFECTIOUS DISEASES - PEDS CHAPTER 15

ADOLESCENTS
Adolescence is thought of as a period of wellness with the individual
seeking health care for:
o Sports physicals
o STDs/STI's
o Pregnancy
During these visits, the health care provider should be aware of
immunization updates for the adolescent.
Adolescents need to receive booster doses of vaccines to maintain high
levels of immunity.
Rates of immunization against measles, mumps, rubella, and hepatitis B
are increasing with the adolescent between the ages of 13 to 15 at or very
near the Healthy People 2010 goal for those diseases.
Approximately 15%of older adolescents remain unprotected against
hepatitis B, a virus that can be acquired through sexual contact.
Prevalence of sexual intercourse as well as the rate of STDs has increased
amongst adolescents
Factors include: unprotected sex, biological susceptibility to disease, and
difficulty in accessing and utilizing confidential health care.
Those at high risk for disease include intravenous drug users, sexually
active heterosexuals and male homosexuals (CDC, 2006)
Adolescents need a booster dose of tetanus and diphtheria vaccine (Td)
about TEN YEARS after their first dose received prior to starting
kindergarten.
Unprotected sexual intercourse and injection drug use have been linked to
an increased rate of STDs.
Preadolescent and adolescents should be seen alone, apart from their
caregivers, during a portion of the interview to assess their knowledge
about disease transmission, especially STDs.
INFECTIOUS DISEASES IN DAY CARE AND SCHOOL SETTINGS
Factors that influence the incidence of infection as young infants and
children are cared for in out-of-home settings such as day care and school,
including the following:
o Personal hygiene and immunization status of the caregiver
o Personal hygiene and immunizations status of the children
o Sanitation of the environment
o Specific procedures for toileting and diaper changing
o Procedures for the handling and preparing of food
o Caregiver-to-child ratio
o Quality and physical space of the facility
o Specific exclusion criteria for children with potentially infectious
illnesses
o Good lines of communication with parents
o Access to qualified health consultants and public health personnel
FAMILY TEACHING

INFECTIOUS DISEASES - PEDS CHAPTER 15

Nurses can teach caregivers about the characteristics of optimal day care
as they relate to the health of the children. One topic of concern is the
facility policy related to illness.
o "Will they allow a child to come to school with a temp of 101F
(38.3C) to attend?"
o "How many days after a fever subsides can the child return to
school?"
o "If child appears with a red, watery eye, what is the center's illness
policy?"
o "Are children who are toilet trained, separated from children who
are not?"
o "Does the staff use frequent hand washing?"
Many out-of-home facilities (whether private or licensed centers, or
schools) have policies regarding the admission of ill children. Children
who have fever, diarrhea, irritability, open mouth sores, rashes, and
purulent conjunctivitis are excluded until the illness is treated
appropriately or till it resolves.
Other diseases including TB, scabies, head lice, hepatitis A, Streptococcal
pharyngitis, impetigo, varicella, mumps, measles, and pertussis, require
specific treatments and time periods during which the disorder becomes
noninfectious. Most of these children need physician proof of no longer
being contagious in order to return to school or day care.
IMMUNIZATIONS
Immunizations are important for health promotion and disease prevention
for all children.
The vaccines used for immunizing against diseases are prepared from
microorganisms or genetically engineered antigens, and introduced into
the body to evoke an immune response.
Can be given mainly by injection but can be given by oral route, and
aerosol.
SCHEDULE OF IMMUNIZATIONS
Clinic staff who remind families of keeping immunizations appointments
can facilitate adherence to immunization guidelines.
When a child receives only one or two doses of vaccine and does not
receive the remaining vaccines according to the recommended schedule,
the series does not need to be restarted, instead only the missed doses
need to be given according to the recommended immunization schedule
for children not immunized during the first year.
COMBINATION VACCINES - See charts on page 477 - 479
The Diphtheria-tetanus-pertussis injection is an example of a combination
vaccine. DTaP now contains acellular pertussis, which prevents many of
the side effects of the whole-cell pertussis vaccine DTwP.
MMR - Measles Mumps Rubella
THE NATIONAL CHILDHOOD VACCINE INJURY ACT

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INFECTIOUS DISEASES - PEDS CHAPTER 15

The National Childhood Vaccine Injury Act of 1986 was estab. in response
to concerns about serious vaccine related injuries and deaths. it is a
system in which persons who have suffered an injury or death as a result
of vaccines may seek compensation. No negligence must be proven, and
the program provides an alternative to civil litigation. The act requires
every child to have a personal immunization record that is maintained in a
permanent medical record. It mandates that the following information be
recorded at the time of each immunization.
o Month, day, year of admin
o Vaccine administered
o Manufacturer
o Lot number and expiration date
o Site and route of administration
o Name, address, and title of the health care provider administering
the vaccine
PRECAUTIONS AND CONTRAINDICATIONS
There are only TWO TRUE, permanent contraindications to vaccination:
1. A history of severe anaphylactic reaction to a vaccine or its component
2. Encephalopathy within seven days of administration of DTP/DTaP.
3. Mild common illnesses such as otitis media, upper respiratory
infections, colds, and diarrhea are NOT contraindications to
immunizations. Precautions must be taken when administering live
vaccines such as measles, mumps and rubella as well as varicella to
adolescent girls and women of childbearing age to make certain that
they are not pregnant at the time of vaccination.
NURSING MANAGEMENT
Nurses need to know about the clinical manifestations, etiology, incidence and
incubation period, as well as the therapeutic management of each disease.
INFECTIOUS DISEASES IN CHILDREN - see page 482 - 489 (I took 2 sets of
photos for the table but they came out horrible and very unclear.).
SEE Table 15-1on page 482 - 489

CYTOMEGALOVIRUS (CMV)
DIPTHERIA
ERYTHEMA INFECTIOSUM (FIFTH'S DISEASE)
INFECTIOUS MONONUCLEOSIS
LYME DISEASE
MUMPS
PERTUSSIS (WHOOPING COUGH)
POLIO
ROCKY MOUNTAIN SPOTTED FEVER
ROSEOLA HUMAN HERPESVIRUS 6
ROTAVIRUS
RUBELLA (GERMAN MEASLES)

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INFECTIOUS DISEASES - PEDS CHAPTER 15

RUEBOLA (MEASLES)
SCARLET FEVER
TETANUS
VARICELLA (CHICKENPOX)
SYPHILIS
HIV
GIARDIA
PINWORMS (ENTEROBIUS)

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