VACCINE PREVENTABLE

COMMUNICABLE DISEASE
PRESENTED BY: TANVI KUNDRA
CHILD HEALTH NURSING
M.SC NURSING,2nd YEAR
HFCON
INTRODUCTION
 DEFINITION
• Communicable diseases are caused by infectious
agents that can be transmitted to susceptible
individuals from an infected person, or from other
animals, objects or the environment . A susceptible
host is a person or animal who can develop infection if
exposed to the infectious agent.
 DIPTHERIA
• Diphtheria is caused by the bacterium
Corynebacterium diphtheriae. This germ
produces a toxin that can harm or destroy
human body tissues and organs. One type of
diphtheria affects the throat and sometimes
the tonsils.
• Another type, more common in the tropics,
causes ulcers on the skin.
 Contd…
• Diphtheria affects people of all ages, but most often it
strikes unimmunized children. In temperate climates,
diphtheria tends to occur during the colder months. In
2000, 30 000 cases and 3000 deaths of diphtheria
were reported worldwide.
 SPREAD AND TRANSMISSION
• Droplet infections
• Can also be transmitted directly to susceptible
persons from infected cutaneous lesions.
• Transmission by objects contaminated by Naso-
pharyngeal secretions of patients is also possible.
 SIGNS AND SYMPTOMS OF DIPTHERIA
When diphtheria affects the throat and tonsils, the
early symptoms are sore throat, loss of appetite, and
slight fever. Within two to three days a bluish-white or
grey membrane forms in the throat and on the tonsils.
This membrane sticks to the soft palate of the throat
and may bleed. If there is bleeding, the membrane may
become greyish-green or black.
 Contd..
• The patient may either recover at this point or
develop severe weakness and die within six to ten
days. Patients with severe diphtheria do not develop a
high fever but may develop a swollen neck and
obstructed airway.
 COMPLICATIONS OF DIPHTHERIA

• During the early phase of the illness or even weeks

later, patients may develop abnormal heartbeats,
which can result in heart failure. Some patients with
diphtheria experience inflammation of the heart
muscle and valves, leading after many years to chronic
heart disease and heart failure. The most severe
complication of diphtheria is respiratory obstruction
followed by death.
 TREATMENT FOR DIPHTHERIA

• Children who develop diphtheria should be given

diphtheria antitoxin and antibiotics, such as
erythromycin or penicillin. They should be
isolated to avoid exposing others to the disease.
• About two days after starting antibiotic
treatment patients are no longer infectious.
 Contd…
• For confirmation of diagnosis, health workers should
obtain throat cultures from suspect cases. However,
treatment should begin without waiting for culture
results.
 NURSING MANAGEMENT
The aims of Interventions are to inactivate toxin, to kill the organism, and to prevent
respiratory obstruction
1. Strict bed rest, strict isolation
2. Cleansing throat gargle may be ordered
3. Liquid or soft diet or parenteral fluid
4. Observe for respiratory obstruction.
5. Suction as needed
6. Oxygen therapy
7. Antitoxin is given against toxin
8. Toxoid is given to immunized contact
9. Broad spectrum antibiotic is given against diphtheria bacilli.
 Contd….

• Cutaneous diphtheria is usually treated by cleaning the wound with

soap and water, and giving the patient antibiotics for 10 days.
• Patients with laryngeal diphtheria are kept in a croup tent or high
humidity environment; they may also need throat suctioning or
emergency surgery if their airway is blocked.
 DIPHTHERIA PREVENTION

• The most effective way of preventing diphtheria is to maintain a high

level of immunization in the community. In most countries, diphtheria
toxoid vaccine is given in combination with tetanus toxoid and
pertussis vaccines (DTP vaccine).
• More recently, some countries have been using a combination
vaccine that includes vaccines for diphtheria, tetanus, pertussis,
vitamin A (HepB), and sometimes Haemophilus influenzae type b
(Hib). Approximately every ten years, booster doses of the adult form
of the vaccine, tetanus-diphtheria toxoids vaccine (Td), may be
needed to maintain immunity.
WHOOPING COUGH (PERTUSSIS) IN
CHILDREN
• Whooping cough (pertussis) is a contagious illness. It causes intense
fits (paroxysms) of coughing. It mainly affects babies and young
children.

• Whooping cough used to be called the "100-day cough" because it

can last for weeks to months.

• Whooping cough is caused by Bordetella pertussis bacteria. It is very

contagious. It’s spread from child to child through coughing and
sneezing. Once the bacteria are in a child's airways, it causes
swelling of the airways and mucus.
 SIGNS AND SYMPTOMS
• The illness often starts like the common cold, with a runny
nose, sneezing, and a mild cough or fever. After 1 to 2 weeks,
severe coughing starts. The cough often ends with a
whooping sound as air is inhaled.
• During coughing spells, it is hard for babies and children to
eat, drink, or breathe. These spells can last for weeks. In
babies, it may cause periods of not breathing (apnea).
Whooping cough is worse for children under 1 year of age. It
is fatal is some cases.
 DIAGNOSIS
• The healthcare provider should ask about child’s
symptoms and health history. He or she should
perform Physical examination. A sample of fluid from
the nose or mucus from a cough may be tested for
the bacteria. This is often done to confirm the
diagnosis.
 TREATMENT OF PERTUSSIS

• In some cases, your child may to go to the hospital for treatment. This is for
supportive care and monitoring. Sometimes, your child may need oxygen
and intravenous (IV) fluids until he or she starts to recover.

• Your child may also take antibiotic medicine. Antibiotics may not make your
child get better faster. But they will prevent the spread of infection to
others. Anyone who has been in close contact with a child with whooping
cough is usually given antibiotic medicine. This is the case even if someone
has had the pertussis vaccine.
 HOME TREATMENT
Home treatment may include:
• Keeping child comfortably warm
• Feeding the child small meals often
• Giving child plenty of fluids
• Preventing things that cause coughing
 NURSING MANAGEMENT

1. Droplet Isolation
2. Provide Bed rest
3. Provide restful environment and reduce factors that promote paroxysm
(dust, smoking)
4. Encourage fluid,small frequent feeding.
5. Observe for signs of air way obstruction.
6. Small amount of sedatives may be necessary to quiet the child.
7. Protect the child from secondary infection,antibiotics may be given to treat
secondary infection.
POSSIBLE COMPLICATIONS OF WHOOPING
COUGH IN A CHILD
• Possible complications of whooping cough in a child

• Whooping cough can lead to lung infection (pneumonia).

• The whooping cough vaccine is routinely given to children in

the first year of life. But cases of the illness still occur,
especially in babies under 6 months of age.
 TETANUS
• Tetanus is a neurological disorder, that is, a disorder of the nervous
system.
• Symptoms of tetanus are tight muscles that are difficult to relax, and
muscle spasms (muscle contractions that occur without the person wanting
them to).
• These problems with the muscles are caused by a toxin (poison)
produced by the bacteria called Clostridium tetani.
• Tetanus in newborns is called neonatal tetanus
 MODE OF TRANSMISSION OF TETANUS:
•People can get tetanus through exposure to tetanus bacteria (Clostridium
tetani) which are always present in the soil.
•The bacteria can be transmitted directly from the soil, or through dirty nails,
dirty knives and tools, which contaminate wounds or cuts.
•A newborn baby can become infected if the knife, razor, or other instrument
used to cut its umbilical cord is dirty, if dirty material is used to dress the cord, or
if the hands of the person delivering the baby are not clean.
•Unclean delivery is common when mothers give birth at home in poor
communities, but it can be prevented by skilled birth attendants.
•The disease is caused by the action of a toxin produced by the bacteria, which
damages the nerves of the infected host. This toxin is produced during the
growth of the tetanus bacteria in dead tissues, in dirty wounds, or in the
umbilicus following unclean delivery of the newborn.
 CLINICAL MANIFESTATIONS OF TETANUS
•The time between becoming infected with Clostridium tetani bacteria and the person
showing symptoms of tetanus disease is usually between three and 10 days, but it may be
as long as three weeks.
•In cases of tetanus, the shorter the incubation period, the higher the risk of death. In
children and adults, muscular stiffness in the jaw, which makes it difficult or impossible to
open the mouth (called ‘locked jaw’) is a common first sign of tetanus.
•This symptom is followed by neck stiffness (so the neck cannot be bent), difficulty in
swallowing, sweating, fever, stiffness in the stomach muscles, and muscular spasms
(involuntary contraction of the muscles).
•Babies infected with tetanus during delivery appear normal at birth, but they become
unable to feed by suckling from the breast at between three and 28 days of age. Their
bodies become stiff, while severe muscle contractions and spasms occur. Death follows in
most cases.
Opisthotonus or severe
backward arching
TREATMENT, PREVENTION AND CONTROL OF TETANUS:

•Once a person has tetanus, he or she will be treated by an antibiotic drug.

Tetanus toxoid (TT) vaccination
•The tetanus vaccine contains inactivated tetanus toxoid, which is why it is often called TT
vaccine. Tetanus toxoid vaccination is given routinely to newborns and infants as part of the
threefold DPT vaccine (with diphtheria and pertussis vaccines), or the Pentavalent (fivefold)
vaccine, which includes vaccines for diphtheria, tetanus, pertussis, Hepatitis B (a virus), and a
bacterium called Haemophilus influenzae type B (Hib).
•Neonatal tetanus can also be prevented by vaccinating women of childbearing age with
tetanus toxoid vaccine, either during pregnancy or before pregnancy.
•This protects the mother and enables anti-tetanus antibodies to be transferred to the
growing fetus in her uterus.
• Cleanliness is also very important, especially when a mother is delivering a baby, even if she
has been vaccinated with TT vaccine.
•People who recover from tetanus do not have increased natural immunity and so they can
be infected again. Therefore they will need to be vaccinated.
 NURSING MANAGEMENT
• Provide complete bed rest to the child.
• Keep the infant in dim lighted, quiet and well ventilated room, as spasms can be
precipitated by bright light, noise or even touch.
• Minimize external stimuli.
• Prompt suctioning and oxygen administration is essential.
• Fluid and electrolyte balance should be maintained.
• Due to spasm and increased muscle activity, patients are exhausted and need
extra calories, so provide high calorie & protein diet to patient.
• NG feed must be given in case of high fever and tepid sponging too.
• Change patients position every 2 hourly to prevent bed sores.
• General hygiene including bath oral care, and elimination should be maintained.
• Care of wound such as removal of necrosed tissue, cleaning with hydrogen
peroxide and treatment with antibiotic ointment is done.
• Regularly monitor vital signs.
STRATEGIES TO PREVENT AND CONTROL TETANUS:
•Vaccinating a higher percentage of pregnant women against tetanus with
vaccines containing tetanus toxoid (TT).
•Vaccinating all females of childbearing age (approximately 15–45 years) with TT
vaccine in high-risk areas where vaccination coverage is currently low.
•Promoting clean delivery and childcare practices, through better hygiene and
care of the newborn’s umbilicus.
•Improving surveillance and reporting of cases of neonatal tetanus. The case
finding and reporting will help us to give appropriate treatment and vaccination
to children.