Communicable Diseases: Rubella, Rubeola, Roseola, Fifth's Disease, Chicken Pox, Scarlet Fever, Mononucleosis

Communicable
Diseases
Rubella, Rubeola, Roseola,
Fifth’s Disease, Chicken Pox, Scarlet Fever, Mononucleosis
 Review terminology r/t communicable
diseases:
◦ Incubation period
◦ Prodromal symptoms
◦ Period of communicability
◦ Types of Isolation: contact, respiratory
 Immunizations can prevent many of these
diseases—primary prevention strategy
 Careful handwashing to prevent transmission
in essential for healthcare practitioners and
for families
 Infection Control: pp. 1019-1020 & Box 27-3
(9th ed.); pp. 193-195 & Box 6-1 (10th ed.)
 Early identification of symptoms so that
treatment can be initiated is also paramount
to a good outcome.
Prevention
 If a child is admitted to the hospital with an
UNDIAGNOSED EXANTHEMA, strict isolation is
instituted until a diagnosis is confirmed.
 These are a few communicable diseases that require isolation:

◦ diphtheria
◦ chickenpox
◦ Measles, mumps, rubella
◦ tuberculosis
◦ adenovirus
◦ Haemophilus influenzae type B
◦ influenza
◦ meningitis
◦ Mycoplasma pneumonia, pseudomonas aeroginosa pneumonia
◦ pertussis
◦ RSV
◦ streptococcal pharyngitis, scarlet fever
◦ Clostridium difficile, e.coli, shigella
◦ pneumonia / pneumonic plague /
 (AAP, Committee on Infectious Diseases, 2003)
 Reportable Communicable Dz list for Cook County
 Any immunocompromised children—those
receiving steroid or immunosuppressive
therapy, are always at risk for viremia,
especially from viruses like herpes zoster.
 Children with sickle cell anemia may develop

aplastic anemia from erythema infectiosum
(EI)[Fifth’s Dz]. The human parvovirus
(HPV) infects and lyses RBC precursors.
 Diphtheria and Scarlet Fever are bacterial

and prevention of complications requires
compliance with antibiotic therapy.
Prevent complications
 High-risk children exposed to chickenpox
should receive VZIG (varicella zoster immune
globulin).
 Acyclovir (Zovirax) may be used to treat

varicella infections in high risk children with
the disease.
 Vitamin A supplementation in high doses has

recently been shown to decrease morbidity
and mortality rates in measles. Careful
instruction to parents on safe storage of
Vitamin A is essential.
Prevent complications
 Alleviate itching that is one of the most
common discomforts of rashes
◦ Cool/tepid baths without soap, may use oatmeal
◦ Calamine/Caladryl lotions must be applied sparingly
to prevent toxic levels being absorbed. They
contain diphenhydramine.
◦ Wear lightweight, loose clothing, keep cool
◦ Keep nails short, wear mittens on young children
◦ Suggest po. Diphenhydramine (Benadryl)
 Offer antipyretics (acetominophen or
ibuprofen) for fever and general malaise
 Lozenges, saline rinses for sore throats
 Suggest quiet activities
Provide comfort
 Provide accurate information re: period of
communicability and period of recovery.
 Provide support and encouragement.
 Review importance of compliance with
therapy.
 No Salicylate products with all viral
diseases because of link to
Reye Syndrome (p.1462-3 10th ed.)—
metabolic encephalopathy: fever, profoundly
impaired consciousness, and liver dysfunction.
Support family and child

 Review Table 16-1 Communicable Diseases of
Childhood pp. 608-614 (Hockenberry et al, 9th ed.)
 Table 6-2 in 10th ed. Pp. 212-218
 Know association of high fever and febrile seizures with
Roseola and importance of careful antipyretic
management.
 Know common sx of Rubeola (measles) including koplik’s

spots, photophobia.
 Know period of communicability of Varicella/chickenpox

and appropriate counsel to parents re: when child can
return to school
 Know etiology of Scarlet Fever, common sx, management,

and when to return to school
 Know risks to fetus if Rubella is contracted in the mother’s

first trimester of pregnancy
 Know appearance of rash for Fifth Disease (HPV)

Which is which??
Fifth Disease
Roseola
Chicken pox
Scarlet Fever
 Etiology: Epstein Barr Virus
 Natural Hx:
◦ Typically self-limiting & uncomplicated
◦ -7Incubation period: 30-60 days
◦ Preclinical stage: 3-5 days
◦ Acute illness: 7-20 days
◦ Convalescence: 2-6 weeks
◦ Viral excretion may occur many months after
infection
◦ Often asymptomatic and difficult to diagnose
Mononucleosis (pp.1175-7 10th ed.)

 Transmission: through saliva (usually
intimate contact, thus the nickname,
‘Kissing Disease’)
 Pathophysiology
◦ EBV infects B-lymphocytes lymphoproliferation
◦ Lab results: atypical lymphocytes called Downey cells
  WBC’s especially lymphs and
  liver enzymes
 EBV antibody titer 
 + Monospot test
Mononucleosis (cont’d)
 Signs and Symptoms
◦ General malaise
◦ Sore throat, gelatinous film over palate and
uvula, red macules on palate
◦ Tonsillar enlargement, white exudate on
tonsils, red pharynx
◦ Fever
◦ Macular rash (trunk)
◦ Abdominal pain
◦ Cervical lymphadenopathy
◦ Splenomegaly
◦ Hepatomegaly
Mononucleosis (Cont’d)
 Population most affected:12-26 yr olds
 Nursing concerns
◦ Potential for secondary infection
◦ Potential for injury
◦ School absenteeism
◦ Possible complications:
 Aseptic meningitis
 Encephalitis
 Guillian Barré Syndrome
 Splenic rupture
Mononucleosis (cont’d)
 Primary prevention
◦ General health promotion measures
 Secondary prevention
◦ Prompt medical attention for sore throats to r/o strep
throat
◦ Screening to r/o secondary bacterial infection
 Tertiary prevention
◦ Palliative:
 Fever (rest,  calories,  fluids, Acetominophen
 Saline gargles
 Soft foods
◦ No contact sports
◦ Referral for home-bound teacher, if pt has to
stay home for lack of energy and malaise
◦ Can go to school if feels up to it
 That should do it!
Wash your hands and stop the

spread of these communicable
diseases!

Communicable Diseases: Rubella, Rubeola, Roseola, Fifth's Disease, Chicken Pox, Scarlet Fever, Mononucleosis

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Communicable

 These are a few communicable diseases that require isolation:

 Children with sickle cell anemia may develop

 Diphtheria and Scarlet Fever are bacterial

 Acyclovir (Zovirax) may be used to treat

 Vitamin A supplementation in high doses has

Support family and child

 Know common sx of Rubeola (measles) including koplik’s

 Know period of communicability of Varicella/chickenpox

 Know etiology of Scarlet Fever, common sx, management,

 Know risks to fetus if Rubella is contracted in the mother’s

 Know appearance of rash for Fifth Disease (HPV)

Mononucleosis (pp.1175-7 10th ed.)

Wash your hands and stop the

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