Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria)

Measles-

• Highly contagious viral respiratory infection § Incubation: 8–12 days

Transmission:

• 4 days after exposure to 4 days after rash has appeared
• Nasal secretions (directly) or respiratory droplets

Clinical Manifestations:

• Fever
• 3 C’s – Conjunctivitis, Coryza, Cough (dry)
• Eyelid edema, photophobia
• Malaise, irritability
• Rash
• Koplik spots – red specks with blue-white center, buccal mucosa, 2 days before rash, disappear within 48 hours of rash onset
• Maculopapular rash – head, trunk, lower extremities, 14 days after exposure, contagious 4 days before to 4 days after rash

Interventions:

• Standard airborne isolation
• Immunization
• Supportive care, treat symptoms, antipyretics

Complications:

• Fetuses exposed during first trimester are at risk for heart defects, developmental delays, deafness, stunted growth

Mumps- 

• Paramyxovirus that causes glandular enlargement of salivary, parotid glands, frequently active in spring

Transmission:

• Respiratory droplets, saliva
• Most contagious 1–2 days before appearance of parotitis
• Remain infectious up to 5 days after onset of glandular enlargement

Clinical manifestations:

• Parotitis
• Low grade fever
• Nonspecific upper respiratory tract infection symptoms – Malaise, Anorexia, Headache

Interventions:

• Standard, droplet precautions
• Immunizations
• Supportive care – analgesics, antipyretics, oral steroids for severe orchitis

Pertussis- (Whooping Cough)

Highly contagious disease caused by gram-negative Bordetella pertussis

• Attaches to respiratory tract ciliated epithelium
• Produces toxin that limits ability to clear secretions

Incubation:

• 7–10 days (varies)

Transmission:

• Respiratory droplets

Clinical Presentation:

• Stage I (Catarrhal) – up to 2 weeks, coryza, sneezing, low-grade fever, occasional cough
• Stage II (Paroxysmal) – up to 6 weeks, worsening cough, paroxysmal bursts of coughing (whoop), worse at night, petechial rash above nipple line
• Stage III (Convalescent) – weeks to months, cough less severe, superinfections due to trapped secretions

Assessment:

• Dacron swab in posterior nasopharynx

Interventions:

• Standard, droplet precautions
• Supportive care
• Macrolide antibiotics
• Antitussives
• Antipyretics

Discharge Teaching:

• Pertussis vaccination
• Household members treat with antibiotics regardless of vaccination status

Chicken Pox- 

• Caused by varicella zoster virus; after primary infection, virus becomes latent

Transmission:

• Respiratory droplets, skin contacts (less common)
• Infectious for 48 hours before rash appears
• Contagious until all skin lesions have crusted over, no new lesions formed

Clinical manifestations:

• Purulent vesicular rash – initially forms on trunk and face, then generalizes
• Fever, headache, anorexia, malaise
• Lymphadenopathy
• Pruritis, urticaria

Interventions:

• Standard, airborne, and contact isolation
• Symptomatic care
• Antiviral agents – >12 yoa, chronic skin or lung disease, on steroid therapy, some pregnant women
• Antihistamines, antipyretics, analgesics
• Varicella immunoglobulin for pregnant patients
• Systemic antibiotics if secondary bacterial infection
• Aspirin should not be utilized in children due to its association with Reye’s syndrome

Prevention:

• Varicella zoster vaccine

Shingles-

• Reactivation of the varicella virus that has lain dormant in the dorsal ganglia following chicken pox

Clinical Manifestations:

• Pain develops first, followed by the characteristic vesicular lesions within 48 hours
• Severely painful, localized, unilateral pain
• Vesicular lesions along nerve dermatome within 48 hours of pain onset
• Typically, does not cross the body’s midline

Interventions:

• Standard, airborne, contact precautions around persons with chickenpox
• Antivirals
• Cover lesions
• Supportive care, comfort measures
• Varicella zoster vaccination

Prevention:

• Shingles can be prevented by proper vaccination

Diphtheria-

• Infection of mucous membranes caused by Corynebacterium diphtheriae
• Diphtheria once was a major cause of illness and death among children, but rates began to drop quickly with vaccination

Incubation:

• 1–8 days

Transmission:

• Respiratory droplets

Clinical Manifestations:

• Sore throat, low grade fever, weakness, swollen glands in the neck
• Thick, gray, membranous covering on tonsils, pharynx – forms within two to three days of infection, characteristic pseudomembrane interferes with respiration, Pseudomembrane is formed from tissue killed by the toxin, Pseudomembrane sticks to tissue below, and cannot be manually removed owing to risk of bleeding

Complications:

• The diphtheria toxin may be absorbed into the bloodstream and may cause damage to the heart, kidneys and nerves
• Myocarditis, Neuritis
• Airway obstruction

Assessment:

• Swab throat for Gram stain, culture, sensitivity
  Toxin analysis specimen
  Polymerase chain reaction

Interventions:

• Standard, droplet precautions
• Vaccination
• Diphtheria antitoxin – counteracts toxin produced by the bacteria
• Start antibiotics treatment immediately if diphtheria is suspected; do not wait for laboratory confirmation
• Erythromycin is drug of choice

Mononucleosis-

• Acute viral illness most commonly caused by the Epstein-Barr virus
• common among teenagers and young adults (college students), spread via body fluids (saliva)
• Typical symptoms usually appear 4–6 weeks after infection

Clinical Presentation:

• Prodrome – fatigue, anorexia, nausea/vomiting, chills, diaphoresis, headache, myalgia
• Illness – low-grade fever, sore/red throat, head/body aches, lymphadenopathy, rash, diarrhea, earache, enlarged tonsils, petechiae on palate
• Complications – hepatomegaly, splenomegaly, thrombocytopenia, pneumonia, meningitis/encephalitis, hepatitis, pericarditis

Assessment:

• Diagnosis based on history and physical
• Specific antibody tests identify specific virus – monospot (usually becomes positive by the second week of illness), Epstein-Barr virus antigen test
• CBC – elevated white blood cell count, unusual-looking white blood cells (atypical lymphocytes)
• Liver function panel – abnormal liver function

Interventions:

• Mostly symptom control – Analgesics, Avoid aspirin, Corticosteroids
• Salivary precautions

Complications:

• Splenic rupture
• Airway obstruction
• Death (rare)

Discharge teaching:

• Avoid strenuous activities for 4 weeks, including contact sports
  Warm saltwater gargles
  Avoid alcohol for 1 month
  Do not donate blood for 6 months
  Seek medical attention for signs of intra-abdominal bleeding